Outcome of Inferonasal Conjunctival Autograft in Pterygium Surgery

This study was done to evaluate the outcome of pterygium excision with inferonasal conjunctival autograft at a tertiary eye care centre. Retrospective analysis of medical records of primary pterygia patients operated by a single surgeon between 2017 to 2020 were analyzed. A total of 43 patients who met the inclusion criteria were included in the study. The demographic variables, along with size of pterygium and recurrence over a period of six month follow up was noted. The mean age of patients was 46.97 years (29-74 years). The mean size of pterygium was 3.17 mm. Recurrence was seen in 3 eyes over a period of 6 months. Graft edema was observed in 11 patients and graft hemorrhage along with congestion was seen in 8 cases which resolved over a 3 weeks follow up period. Mild conjunctival scarring was seen over donor area in 5 of the eyes. Pterygium excision with inferior conjunctival autograft is an effective alternative technique to superotemporal autograft technique.

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.

Survey of Impression Materials and Techniques Used in Fixed Prosthodontics among Nepalese Dentists

There is variation in fixed prosthodontics practice and many studies have concluded that clinicians definitely deviate from the recommended clinical protocols. If this happens during treatment with fixed prosthesis, the quality of fixed prostheses is compromised which affects it’s long term survival. Therefore, the aim of this study was to evaluate the use of impression materials and techniques in fixed prosthodontics among Nepalese dentists and to compare the findings on the basis of educational level and years of experience. A cross-sectional, questionnaire-based online survey was done amongst the Nepalese Dentists through google forms. Data from the completed questionnaires were analysed using the SPSS version 16. All statistical analyses were carried out at a significance level of P < 0.05. Out of 129 participants, 68 (52.7%) dentists often made diagnostic impression for fabrication of study cast. 85(65.9%) dentists used Addition silicone, 11(8.5%) used Condensation silicone and 33(25.6%) used Alginate for final impression making. Most commonly used elastomeric impression technique was Putty Wash single stage (56.2%), 40.7% used Putty Wash two stage, 3.1% used Single mix (Monophase) technique. Regarding retraction cord, 63.5% of dentists used Plain gingival retraction cord and 35.7% of dentists used Chemical impregnated retraction cord. Conclusion: The study found that most of the responses on use of impression materials and techniques were significantly associated with the level of education and clinical experience.

Morphological Variations of the Lungs: A Cadaveric Study

The lungs are the organs of respiration which are situated on either side of the heart and other mediastinal contents in its pleural cavity. A fresh lung is spongy, can float in water and crepitates when handled. Lungs are important with respect to its blood circulation. The lungs are divided by fissures into lobes which facilitate movements of lobes in relation to one another. The hilum of each lung is its gateway. In the present study, we aim to assess the morphological variations of human cadaveric lungs at Chitwan Medical College (CMC). An observational study was conducted at dissection hall of anatomy department at Chitwan Medical College from September 2019 to October 2020 after taking ethical approval form Institutional Review Committee of CMC. All the intact 70 lungs present in the department were studied. Photographs of the intact lungs were taken from different surface. The lungs were porus, highly elastic and spongy in texture. On keeping lungs to water tank it got floated. We found 34(80.96%) of the studied specimen of right side had horizontal fissure present in it. The remaining 8 (19.04%) specimens did not have horizontal fissures, while 3 (5.88%) specimens had incomplete fissures. The oblique fissure was not present in 2 (2.38%) of the study specimens. The left side of the study specimen has a variance of 1(4.16%). When the hilum right lung was examined, 40 (95.23%) of the structure had the usual organization pattern. In the left lung, the usual pattern of organization was 21(75%). The differences are thought to be present in the lung’s fissure and hilum. The current study’s findings are therapeutically important. The findings could prove beneficial to cardiovascular and thoracic surgeons.

Anterior Skull Base Analysis from Coronal and Reconstructed Computed Tomography: Radio-Anatomical Study

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

Prevalence of Multidrug-resistant and Carbapenemase-producing Klebsiella Pneumoniae and Pseudomonas Aeruginosa Isolates in Tertiary Care Hospital in Kathmandu, Nepal

Carbapenemases are the enzymes that catalyze β–lactam groups of antibiotics. The carbapenemase producers are resistant to β–lactam antibiotics and are usually multidrug-resistant bacteria challenging widely used therapeutics and treatment options. Therefore, the detection of carbapenemase activity among clinical isolates is of great therapeutic importance. We aimed to study the MDR and carbapenemase-producing Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from various clinical samples at a tertiary care hospital in Nepal. A total of 3,579 clinical samples were collected from the patients visiting the Department of Microbiology, B&B Hospital, Gwarko, Lalitpur. The samples were processed to isolate K. pneumoniae and P. aeruginosa and then subjected to antibiotic susceptibility testing (AST) by the Kirby-Bauer disk diffusion method. Phenotypic detection of carbapenemase activity was performed in the imipenem-resistant isolates by the modified Hodge test (MHT). Of the total samples, 1,067 (29.8%) samples showed significant growth positivity, out of which 190 (17.3%) isolates were K. pneumoniae and 121 (11.3%) were P. aeruginosa. Multidrug resistance was seen in 70.5% of the K. pneumoniae isolates and 65.3% of the P. aeruginosa isolates. Carbapenemase production was confirmed in 11.9%, and 12.2% of the imipenem-resistant K. pneumoniae and P. aeruginosa isolates, respectively, by the MHT. This study determined the higher prevalence of MDR among K. pneumoniae and P. aeruginosa; however, carbapenemase production was relatively low.

Giant Soft Tissue Sarcoma of Scalp with Skull and Cerebral Invasion

Scalp soft tissue sarcomas (STS) are very rare accounting for less than 0.1% of all malignancies. We report a rare clinical image of advanced stage soft tissue sarcoma of the scalp. A 65 year woman had presented to the surgical department with complaints of a rapidly growing swelling over the scalp for three months. On examination there was huge 20 x 20 cm swelling over the scalp in the left temporoparietal region with variegated consistency. Computed tomography of head revealed a large soft tissue mass with necrosis invading the bone and underlying brain parenchyma. Histopathological finding from core needle biopsy revealed pleomorphic sarcoma. STS are highly malignant tumors which should be diagnosed and treated using multimodality approach. Recurrences are common even after complete resection and prognosis is poor.

Pattern of Alcohol Use and its Effects in Relation to the Age of Initiation of Alcohol Use among the Residents of Jhaukhel Area of Bhaktapur District

Over the past few decades, alcohol consumption has increased in quantity and frequency. Several studies have suggested that people who start drinking at younger age have an increased risk of alcohol use disorder. This study was carried out to assess the pattern of alcohol consumption in relation to the age of initiation of alcohol use among the residents of Jhaukhel area of Bhaktapur district. A cross sectional descriptive survey was conducted in Jhaukhel area of Bhaktapur district among the permanent residents aged 15 years and above through a purposive sampling technique using a pre tested self-constructed proforma. Assessment of alcohol use, harmful/ hazardous drinking and alcohol dependence was done using an AUDIT questionnaire as a tool. Chi-square test and Fisher’s exact test were applied and ‘p’ value was calculated to see the association between age of onset of alcohol use and the alcohol use pattern and effects. The level of significance was set at 5%, and ‘p’ value of < 0.05 was considered statistically significant. A total of 190 respondents were interviewed. Mean age of the respondents was 41.25 ± 16.4 years while mean age of initiation of alcohol consumption was 20 ± 4.3 years and 31 (30.4 %) of drinkers initiated alcohol consumption before legal drinking age (18 years). This was more among males (36.5%) than females (14.3%), (p-value: 0.03, OR: 3.4, 95%CI: 1-11) Initiating alcohol consumption early in life before 18 years was strongly associated with binge drinking pattern (P value: <0.001, OR: 9.5, 95%CI: 2.7-33.3). Those who initiate drinking before 18 years were more likely to suffer from alcohol related medical problems compared to those who initiated drinking after 18 years (OR: 6.63, 95% CI: 2.3-19.3, P value: 0.001). Parental consumption of alcohol was found to be associated with the early initiation of alcohol use (OR: 2.7, 95%CI: 1.01-6.96, P value: 0.03). Early initiation of alcohol consumption before legal drinking age was not only a predictor for binge drinking and alcohol dependence, but also a risk factor for alcohol related medical problem, accidents and self-inflicted injuries. Hence this is a serious issue which needs to be addressed at the individual, family as well as community level.

Serum Lactate Dehydrogenase Level in Pregnancy Induced Hypertension and Fetomaternal Outcome

Hypertensive disorders complicate 5-10% of all pregnancies and associated with potentially dangerous maternal and fetal complications. Studies have shown that pre-eclamptic patients with higher levels of lactate dehydrogenase (LDH) are at high risk of developing subsequent complications with poor maternal and fetal outcome. So with the aim to correlate serum LDH level in pregnancy induced hypertension (PIH) with fetomaternal outcome this hospital based observational descriptive study was done at Tribhuvan University Teaching Hospital (TUTH) for the duration of 1 year from 15th May, 2018 to 14th May, 2019. Women with PIH fulfilling inclusion criteria were enrolled in the study. Serum LDH level was measured and severity of PIH, maternal and perinatal outcome were studied according to the levels of LDH. Results were analyzed using SPSS 18. The incidence of hypertensive disorder in pregnancy was 4.74% in this study and total 180 cases were enrolled. The mean serum LDH level increased with increase in severity of PIH. Thirty two (17.7%) cases had maternal complications and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome was most common complication. More than 2/3rd (62.5%) of cases with LDH level >800 IU/L had complications. The most common perinatal complication was intrauterine growth restriction (IUGR). The perinatal morbidity and mortality were significantly high in patients with PIH with LDH level >800 IU/l. As with the increase in serum LDH level increase in maternal and fetal complications was observed, LDH can be a useful biochemical marker that reflects the severity of PIH.

Puerperal Complications in a Tertiary Hospital

Postnatal period is considered as an important part in reproductive life of women. Even though the antenatal phase and labour are utmost important, puerperal phase of pregnancy cannot be overlooked. Puerperal complication can sometime lead to diabilities for lifelong of women. For the prevention of postnatal complication, antenatal prepadareness is needed. The objective of this study was to find out the incidence of puerperal complications and associated risk factors. This is a retrospective, descriptive study conducted at Tribhuvan University Teaching Hospital, Department of Obstetrics and Gynaecology from April 2019 to March 2020. The cases of puerperal complications were noted from the record book from ward. The individual files were collected from record section. Data was collected from record files and analysed. Total number of deliveries were 4932 in one year. Out of which, 84 cases (1.7%) were admitted due to various puerperal complications. Majority of the women admitted with puerperal complications were between 21-29 years, 59.5%. Sixty-four percent (n=54) were primipara and 35.7%(n=30) were multipara. Seventy-six (90.5%) were term deliveries, 6(7%) were preterm and 2(2.4%) were post term deliveries. Sixty-two (74%) had emergency cesarean section as mode of delivery. Major indication of emergency cesarean section was fetal distress (29.8%, n=25). Surgical site infection (53/84,63%) was the commonest puerperal complication followed by puerperal sepsis (8/84,9.5%). Fifty- three cases of surgical site infection (SSI) were observed in patients who had undergone emergency cesarean section. Associated medical condition like hypertension, diabeties, anemia, obesity was seen in 33.5% (n=33) of the cases. Surgical Site Infection is the most common puerperal complication and commonly seen in women who had undergone emergency cesarean section.