Importance of moisturizers in skin

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Surgical outcome of intradural extramedullary spinal cord tumors - Our experience at a tertiary health care center

Introduction: To report the treatment results of 19 patients who underwent excision of intradural extramedullary (IDEM) spinal tumors. Materials & Methods: This is a retrospective study. Patients’ records were retrieved from the electronic database of Grande International Hospital. There were 19 IDEM spinal tumors excised over a period of 6 years between January 2013 and August 2019 by a single surgeon. There were 11 (57.9%) males and 8 (42.1%) females with an average age of 48.37±21.87 years (range, 5-79 years). The mean postoperative follow-up period was 12.87±14.88 months (range, 15 days - 60 months). The histopathological findings, locations of the tumors, and clinical results were analyzed. Neurological findings were evaluated using ASIA grading system and pain was evaluated using VAS score. Results: Histopathologically the tumors were: 8 meningioma (42.1%), 4 schwannoma (21.1%), 4 neurofibroma (21.1%), 1 dermoid cyst (5.3%), 1 lipoma (5.3%), and 1 myxopapillary ependymoma (5.3%). Tumor locations were: dorsal in 10 (52.6%), lumbar in 5 (26.3%), lumbosacral in 2 (10.5%), dorsolumbar in 1 (5.3%), and cervical in 1 (5.3%) patient. Neurologic status of 7 patients was normal and 12 had neurologic involvement with 3 patients having Cauda Equina Syndrome (CES) preoperatively. At the final follow-up, 3-grade, 2-grade and 1-grade improvement in ASIA score was observed in 1, 6 and 1 cases, respectively. There was no change in the ASIA grade in 1 case. All 3 cases of CES achieved full neural recovery. Preoperative VAS score was 9.21±1.08 and improved significantly to 0.74±1.62 after surgery. Neurological improvement was seen in 91.67% with complete recovery in 75% of the cases and not a single case deteriorated neurologically post-surgery. Conclusion: Most intradural-extramedullary spinal cord tumors are mostly benign and good clinical results can be obtained when adequately treated with surgery.

Comparison of laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: A meta-analysis

For many decades, D2 procedure has been accepted in the far-east as the standard treatment for both early (EGC) and advanced gastric cancer (AGC). In case of AGC, the debate on the extent of nodal dissection has been open for many years in order to highlight the safety and efficacy of treatment, hence this study. A comprehensive literature research was performed in PubMed to identify studies that compared laparoscopic- assisted gastrectomy (LAG) and open gastrectomy (OG) with D2 lymph node dissection (D2-LND) for treatment of AGC for the last five years. Data of interest were checked and subjected to meta-analysis with RevMan 5.3 software. The pooled risk ratios (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated. Overall, 19 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD -2.31; 95% CI -4.09 to -0.53; P = 0.01), less blood loss (WMD -120.49; 95% CI -174.27 to -66.71; P < 0.01), faster bowel recovery (WMD -0.55; 95% CI -0.86 to -0.24; P ˂ 0.01) and earlier ambulation (WMD -0.75; 95% CI -1.38 to -0.11; P = 0.02). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.94, 95% CI, -2.95 to 1.06; P=0.36), a lower complication rate [odds ratio (OR)=0.80; 95%CI, 0.68-0.97; P=0.02], and overall survival (OS) and disease-free survival (DFS) comparable to OG. In conclusion, for AGCs both techniques (LAG and OG) appeared comparable in short- and long-term results. More time was needed to perform LAG; nonetheless, it had some advantages in achieving faster postoperative recovery over OG. In order to clarify this controversial issue ongoing trials and future studies are needed.

ABO blood group discrepancies: Study of prevalence and related factors

Background: ABO discrepancy is any deviation from the expected pattern of red cell antigen grouping with serum-grouping or when the forward-grouping results do not correlate with reverse-grouping results. This study was done to determine the incidence and causes of ABO discrepancies and to identify the correct blood group for safe blood transfusions. Methods: This is a retrospective descriptive study. It was done on 9970 samples collected between June 2017and May 2018. All ABO typing records kept at the Grande International Hospital (GIH) blood bank laboratory were reviewed. Results: During the study period, 9970 blood grouping tests were performed. ABO discrepancies occurred in 26 of them. Discrepancies were more prevalent in the age of 20-30 and 30-40 years. Majority were seen in patients with history of pregnancy/miscarriage (30%) and with any Carcinoma (23%). The most common blood group involved was B with 34% frequency. 96% were reverse discrepancy type, 84% with extra antibody which was resolved by incubating the sample at 37°C for 30 minutes signifying most probably A and B subgroups and auto/allo antibodies. Conclusion: This study emphasizes the need of considering ABO discrepancies in blood banks for donors and recipients for safe blood transfusion to avoid any fatal complications. This discrepancy ratio of 1/384 is more than in other studied population of other countries and also higher than ABO mismatched transfusion in standard centers in Nepal. Repeat testing and investigating for ABO subgroups and auto/allo antibodies is important.

Hyperdense middle cerebral artery sign

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Life style factors associated with the risk of type 2 diabetes mellitus

Introduction: Type 2 diabetes mellitus is the commonest form of diabetes affecting more than 90% of the diabetic population worldwide. The prevalence of type 2 diabetes and its complications are increasing in the world, including developing nations like Nepal. This study aimed to determine the association between the lifestyle risk factors and the risk of type 2 diabetes mellitus in Nepalese population. Methods: This is hospital based cross sectional observational study done in the urban area of Nepal. Records of clients coming for the general health checkup in Grande International Hospital were evaluated in this study. Comparisons of the lifestyle factors in participants having and not having type 2 diabetes mellitus were done. Results: Significant associations with diagnosis of diabetes mellitus (DM) type 2 were seen in age (P ≤ 0.001), associated hypertension (P ≤ 0.001), dyslipidemia, family history of DM (P ≤ 0.001), alcohol use (P ≤ 0.001), and tobacco use (P ≤ 0.001). Logistic regression analysis showed that the odds of having diabetes were high in age group above 40 (OR – 6.9, CI 3.82 – 12.47), history of hypertension (OR- 3.84, CI 2.42 – 6.08), tobacco users (OR-2.26, CI 1.12 – 4.53), alcohol users (OR-3.99, CI 2.47 – 6.44), family history of DM (OR-2.44, CI 1.53 – 3.89), and abdominal obesity in both males (OR-3.9, CI 2 – 7.4) and females (OR-9.6, CI 3.78 – 24.35). Conclusions: The modifiable risk factors - obesity, smoking and alcohol use carry significant risks of developing type 2 diabetes. These red flag signs call for urgent attention to look for and rectify the modifiable risk factors in Nepalese population to prevent diabetes.

Prevalence and pattern of hand eczema in a tertiary referral hospital of Nepal

Background: Hand eczema is a very common condition that has a significant effect on an individual’s life in terms of daily functioning including various occupations. Studies show that the point prevalence of hand eczema is around 4% and the lifetime prevalence is 15%. Objective: The objective of this study is to determine the prevalence and pattern of hand eczemas in patients attending the Dermatology outpatient department of Bir hospital. Materials and methods: This is a retrospective study, where all the cases of hand eczema who presented to the Dermatology Out-Patient Department of Bir Hospital during the period from Baisakh 2075 till Chaitra 2075 B.S were recorded. Results: Eczema was diagnosed in 5,100 new cases (15.74%) and among them, hand eczema was seen in 494 cases, which accounts for 9.68% of all eczemas. The mean age was 37.43 years. Out of all the hand eczemas recorded, 334 (67.6%) were unspecified hand eczemas, pompholyx was seen in 92 (18.6%) cases, chronic hand eczema in 27 (5.5%), contact dermatitis in 20 (4%) patients and finger tip eczema was seen in 15 (3%) cases. Conclusion: Hand eczema is one of the common dermatological conditions. Our study showed the prevalence of hand eczema to be 9.68%.

Comparison of single shot caudal Ropivacaine and Bupivacaine in paediatric patients undergoing herniotomy

Background: Inguinal hernia repair is a common surgical procedure in children. Caudal block is an appropriate technique for the treatment of post operative pain in children undergoing herniotomy. This study compared the effects of Ropivacaine and Bupivacaine in caudal block in children undergoing herniotomy. Methodology: A total of 74 patients between 5-16 yrs undergoing herniotomy were randomized in two groups. In Group B, 0.75ml/kg of 0.25% caudal Bupivacaine was administered whereas Group R received 0.75 ml/kg of 0.25% caudal Ropivacaine. Pain score was assessed using Wong Baker pain scale in post operative period and motor power was assessed using modified Bromage scale till 6 hours. Results: The mean duration of post operative analgesia was found to be 253.51 ± 11.48 minutes in Bupivacaine and 258.1 ± 12.10 minutes in Ropivacaine group. The median duration of motor block was 180 (Q1 60- Q3 180) minutes in Bupivacaine and 30 (Q1 22.5- Q3 45) minutes in Ropivacaine group which was statistically significant. There was complete recovery of motor block by 2 hour in Ropivacaine and by 4 hour in Bupivacaine group. (p value< 0.001). Conclusion: From the current study, it is concluded that caudal Ropivacaine at 0.25% concentration and 0.75ml/ kg provides similar duration of post operative analgesia with less motor block in comparison to Bupivacaine.

Preliminary assessment of knee laxity after anterior cruciate ligament reconstruction using bone patellar tendon bone and hamstring graft

Introduction: Laxity after anterior cruciate ligament reconstruction is one of the troublesome problems lasting many years. Laxity can be tested by clinical and arthrometer preoperatively as well as postoperatively. The purpose of this study is to evaluate postoperative laxity in Nepalese population. Materials & methods: This retrospective study was carried out in Grande International Hospital, Kathmandu. All cases which had completed six-months follow up and presented in outpatient department were included in the study. Laxity was tested by Karl Storz Arthrometer using anterior force in 20 degrees of knee flexion with maximum manual force by the same doctor. The statistical significance level was set at p=0.05. Statistical analysis was done using SPSS 16. Results: 21 cases operated via arthroscopic method were eligible for the study. Mean age was 28.3±10.44. There were 14 (66.7%) male 7 (33.3%) female. A total of eight cases of laxity (36.36%) were identified - six males (75%) and two females (25%). Hamstring grafts accounted for three cases of laxity (37.5%) while Bone Patellar Tendon Bone Graft (BPTB) accounted for five cases (62.5%). The mean follow-up was one and half years. Hamstring and bone patellar tendon bone graft were used in 6 (28.6%) and 15 (71.4%) cases respectively. Conclusion: Previous studies have concluded that >3mm of laxity difference is associated with difficulties in vigorous activities. However, our patients were comfortable in their daily activities without significant clinical outcome.

Cancer patients in complementary and alternative medicine: More harm

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