Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.
Introduction Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center. MethodsA retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital. ResultsThirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days. ConclusionNasal bone fracture needing reduction was common following physical assault in males predominently of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice.
Decades of refinement and modifications have led the modern anaesthetic practice to be conducted so smoothly and safely, that sometimes we take for granted the enormous amount of risks involved with it. Furthermore, with the evolution of monitoring techniques, and discovery of safer drugs, anesthesia has facilitated the conduction of complex surgeries on sicker patients, and older patients. The expansion to critical care and pain management services has added another dimension to this field, with anesthesiologists not just working as facilitators for another procedure, but acting as primary physicians. Anesthesiologists are among the few clinicians, who are involved in patient morbidity and mortality in their daily routine. With the ever-changing ethical and legal background, the significance of obtaining a separate consent for anesthesia needs to be timely evaluated. In this review, we have discussed the significance of a separate consent for anesthesia and highlight its various aspects.
Introduction: Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population. Methods: All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors we rerecorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation. Results: A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the studyperiod. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011). Conclusion: Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation.
Introduction: Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low-income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, paediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods: Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminale could be done in 8 patients. Follow up varied from 6 months to 2 years. Results: This study included 8(61.5 %) patients of lumbosacral LMM, 3(23%) patients of sacral LMM and 2( 15.38%) patients of thoracolumbar LMM . About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of postoperative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion: Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration.
Introduction: The number of leprosy patients is increasing in Nepal even after declaration of elimination in 2010. The objective of this study was to review the status of leprosy after declaration of elimination in Nepal and to identify challenges to sustain elimination. Methods: This was retrospective study conducted by reviewing the annual data published by Department of Health Services, Ministry of Health, and Government of Nepal from 2010 through 2018. In addition, one year hospital based data (2017/18) was retrieved from records of Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results: The prevalence of leprosy was found to be 0.77/10,000 population in 2010 and 0.99/10,000 in 2018. The numbers of multibacillary (MB) cases (remained more than 50%) outnumbered paucibacillary (PB) cases throughout eight years. Conclusion: The prevalence of leprosy is gradually increasing in Nepal with more number of multi bacillary cases detected in post-elimination era.
Introduction: Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital. Methods: A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultra sonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method. Results: The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female where as in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion. Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases (p=<0.001). Similarly, Diabetes mellitus was found significant for GSD (p=0.001). 98% cases and 61% in control group were Non-vegetarians with significant p value of 0.021. Smoking (p=0.005), Non-vegetarian diet (p=0.021), family history of gall stone disease (p<0.001) and parity (p<0.001) were also found significant for the gall stone disease. Conclusion: High BMI, non-vegetarian diet, family history of gall stone disease, diabetes mellitus, smoking and increased parity were associated with gall stone diseases.
Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.
Introduction: Infection of the central venous catheter (CVC) is a major complication seen among patients undergoing hemodialysis. Identifying CVC related infection (CRI) and its risk factors and causative organisms is important for better implementation of preventive strategies. Methods: A prospective study was conducted at Chitwan Medical College for duration of 2 years from January 2017to December 2018 among the patients undergoing hemodialysis via CVC. The data collected were related to patients’ demographics, site of catheter insertion, and duration, microbiological data including cultures from catheter sites, blood, and catheters’ tips and antibiotic sensitivity. Catheter related infection was divided into catheter related local infection (CRLI) and catheter related blood stream infection (CRBSI). Data was analyzed using IBM SPSS Statistics version 21.0. Results: A total of 41 cases of CVC related infection (CRI) were documented with an incidence rate of 6.94 episodes per 1000 catheter days at risk. Out of the total CRI, 39.02% were CRLI and 60.98% were CRBSI. Fever with chills and rigor were the most common clinical presentation. Risk factors for the development of CRI were duration of catheter in situ, repeated change of CVC and the use of CVC for indications other than hemodialysis (HD).Staphylococci and Klebsiella were the most common organisms isolated in culture. Conclusion: The rate of CRI among Nepalese patients undergoing hemodialysis is high. Prolonged duration of CVC usage, recent change of catheter and the use of the HD catheter for the purpose of institution of intravenous medication have been found as the risk factors for CRI.
Introduction: Malnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluating nutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutrition screening tool and anthropometry. Methods: This was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed using the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF,MUAC and MAMC. Results: The mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) was the most common etiology while management of tense as cites (40%) was the most common reason for hospital admission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Nascore was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF and MAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and high-risk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them. Conclusion: A significant number of patients had moderate to severe risk of malnutrition that correlated well with anthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease among these patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, they can be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice.
Introduction: Myocardial protection during Coronary Artery Bypass Graft (CABG) has always been an area of concern so we aimed to evaluate the level of release of Creatine Phosphokinase (CPK-MB) and Troponin I (cTnI) at various time intervals in the first 24 hours after on pump CABG in patients receiving either Sevoflurane or Isoflurane. Furthermore clinically relevant patient outcomes were also evaluated in patients undergoing on pump coronaryartery bypass grafting. Methods: This was a prospective randomized trial in patients undergoing on pump coronary artery bypass graft surgery, which was conducted from January 2016 till June 2017. A total of 105 patients were enrolled out of which there were 53 in Isoflurane and 52 in Sevoflurane group who received the respective volatile anesthetic agents throughout the surgery except during bypass at 1-1.5 MAC. The primary outcome was comparison of the CPK MB and cTnI levels at 0 hr, 6 hr, 12 hr and 24 hr after surgery from baseline, whereas the secondary outcomes were duration of intensive care unit stay, usage of vasopressors and inotropes, renal dysfunction, stroke. Results: No significant difference in CPK MB and cTnI levels at all time intervals in both the groups, the other secondary outcome parameters were comparable. Conclusion: The study found no difference in the cardiac markers between the two anesthetics. Based on the data, Sevofluraneand Isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation without any difference in their myocardial protection function.
Introduction: Emergency services are the gateway between the community and hospital that provides 24-hour access for most needy patients in critical and emergency conditions. Mortality rate varies in emergency department across the world and even in different emergency units of the same hospital. This retrospective study was done in adult emergency services of a tertiary hospital to determine mortality rate and analyze causes of death. Methods: A retrospective observational study of mortality cases to analyze mortality rate and causes of death of patients for a period of 6 months between October 2017 to March 2018 was carried out in the adult emergency services of Tribhuvan University Teaching Hospital, Kathmandu. Data required were collected from copies of death certificates. Results: During the study period, a total of 128 patients died in emergency, accounting 0.5% of total patient. Male deaths (52.3%) were slightly higher compared to female deaths (47.7%). Age group 66-75 years had the highest (24.2%) of total mortalities in the emergency. The most common immediate cause of death was sepsis/septic shock (21.9%) followed by cardiopulmonary arrest, aspiration, respiratory failure, other causes of shock and poisoning. The commonest antecedent cause of death was attributed to respiratory causes. Similarly, the most common contributory cause of death was chronic obstructive pulmonary disease. Conclusion: Older age group are prone to the mortality risk. Sepsis/septic shock was the most common immediate cause of death. Pneumonia was the most common antecedent causes of death. Chronic obstructive pulmonary disease was the commonest contributory cause.
Introduction: Cardiovascular diseases are the commonest cause of death globally account for approximately 12 million deaths annually and are the major contributor to the burden of premature mortality and morbidity1. Coronary Artery Disease (CAD) is becoming a major cause in the developing world as well. Asians have been associated with a more severe form of CAD that has its onset at a younger age group with a male predominance2. Methods: The study was carried out for the identification of clinical profiles, risk factors and to know the severity of coronary lesions in angiography in acute myocardial infarction. We enrolled 200 consecutive patients with clinical history and typical ischemic ECG changes admitted in Man Mohan cardiothoracic vascular and transplant center through emergency department from January 2016 to December 2017. A predefined Performa was completed to every patient with a detailed clinical history, physical examinations, and investigation studies. The clinical history revealed information about age, gender, risk factors, and modes of presentation and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The regions of infarction and rhythm disturbances were also documented by 12 lead ECG Results: The study showed a significant male predominance with mean age being 54.5 years. The commonest presenting symptom was chest pain (90%), followed by sweating (86%) and. Breathlessness (62%) Tobacco was identified as major risk factors (62%) followed by Hypertension (42%), Diabetes (38%) and strong family history of CAD (28%), Dyslipidemia (26%) & obesity (BMI >25) is least common risk factor (19%) in this study. Patients had typical chest pain (90%) and ECG showed anterior wall changes in 51%. Angiography revealed Left anterior descending (LAD) was the most common culprit artery (41%) followed by Right Coronary Artery (RCA) in STEMI and Left Circumflex Artery (LCX) and multi vessel involvement in NSTEMI. Complications developed in 42.5% of patients, majority being different type of arrhythmias (56%) and least common is mechanical complications (3.5%). All the patients with mechanical complications died in the hospital. Conclusion: Thus we conclude that AMI is more common in adult male, typical chest pain was the most common presenting symptoms with tobacco use being the major risk factors, anterior wall was the most common STEMI and LAD was the most common culprit artery, Multi vessel with LCX was the predominantly involved in NSTEMI in our study population.
Introduction: Hydatidiform mole is benign form of gestational trophoblastic disease characterized by hydropic swelling of the chorionic villi and proliferation of the trophoblasts. The majority of Hydatidiform mole is cured by simple surgical intervention. The disease can re-occur. The patients are followed up with serial serum BhCG till the normal level is achieved. With raised, plaetue level of serum β-hCG values, persistant GTD is diagnosed. So the proper monitoring and follow up of gestational trophoblastic disease is a must. It reduces both the morbidity and mortality of the women. This study details the clinical profiles and outcome of molar pregnancy. Methods: This is an observational study conducted in Department of Obstretrics and Gynaecology at Tribhuvan University Teaching Hospital from 1st May 2015 to 30th April 2017 (2 years). Patients with the provisional diagnosis of molar pregnancy during the study period were included. After all required investigations, cases were managed according to the diagnosis. And were followed up with serial serum B-hCG. Further required treatment was given according the histopathological diagnosis. Results: Total 46 cases of gestational trophoblastic disease (GTD) were diagnosed and it accounted for 4.9 per 1000 deliveries. Majority of patients belonged to age group of 20-40 years, presented during second trimester with amenorrhoea and per vaginal bleeding. Among these patients 93% (n=43) had suction evacuation, 5 % (n=2) had total abdominal hystrectomy with bilateral salphingo oophorectomy (TAH BSO), 2 % (n=1) had suction evacuation and laparotomy with untwisting of twisted theca luteal cyst. Thirteen patients developed persistent gestational trohphoblastic tumour (PGTT) and six patients were diagnosed as gestational trophoblastic neoplasia (GTN) and managed with multiagent chemotherapy. Conclusions: Any deviation from normal norms in pregnancy or post delivery, gestational trophoblastic disease has to be thought of. Along with proper diagnosis and management, counseling regarding follow up should also be emphasized, which not only reduces morbidity but also reduces the mortality.
Introduction: The purpose of this study was to determine the dimensions of the renal arteries (length and diameter), among the patients referred for Contrast Enhanced CT(CECT) of abdomen in department of Radiology and Imaging, Tribhuwan University, Teaching Hospital. Methods: This prospective study was performed in Department of Radiology and Imaging TUTH with A total of 135 (73 male and 62 female) patients underwent CECT abdomen from June to September 2018. In this study the diameter of right and left renal arteries, the length of right and left renal arteries were determined. Results: The mean values of right renal artery diameter were found to be (0 .5706 ± 0.09861 cm) in males and (0.5061 ± 0.08384 cm) in females respectively. The mean values of left renal arteries diameter were found to be (0.5889 ± 0.10351 cm) in males and (0.5354 ± 0.10552 cm) in females respectively. The mean values of right renal artery length were found to be (4.568751 ± 0.83128cm) in males and (4.0318 ± 0.87575cm) in females respectively. The mean values of left renal arteries length were found to be (3.5990 ± 0.79567cm) in males and (3.2002 ± 0.59207cm) in females respectively. The diameter of renal artery diameter exhibited statistically significant differences in relation to age of the patients (p<0.05) with peak values in 55- 64 years age group where the mean right and left renal arteries diameters were found to be 5.801 mm and 6.012 mm respectively. Conclusion: This study concluded that the diameter of the renal arteries varies significantly with the age of the patients.
Introduction: Optic disc edema can be a manifestation of various neurological disorders. Identification of those causes is possible in most cases using tests like visual acuity, color vision, visual field and suitable radiological imaging. Study in Nepalese population with regard to optic disc edema is scarce. Hence this study aims to act as a guideline for evaluation of such cases and help in further studies in this regard. Methods: A descriptive, cross-sectional study was conducted in all cases of optic disc edema presenting to neuro-ophthalmology clinic of B.P. Koirala Lions Centre for Ophthalmic Studies from January 2011 to June 2012. A detailed history was obtained and proper ocular and nervous examination was done by ophthalmologist and neuro-physician. Assessment of visual acuity, color vision, contrast sensitivity and visual field along with radiological tests were done in all possible cases. Results: Out of all the cases evaluated, 38 cases where causes of optic disc edema could be established were included in the study. The commonly affected age group was 31 to 40 years (26.3%) and most of them were males. The commonest cause observed was optic neuritis (36.8%). Others were papilledema, idiopathic intracranial hypertension, toxic optic neuropathy, non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive and traumatic optic neuropathy. Conclusion: Optic neuritis and papilledema should be considered as common differential diagnosis in patients with optic disc edema. NA-AION is a relatively uncommon disease among Nepalese population.
Introduction: Academic stress in nursing students is a common mental distress with respect to some anticipated frustration that is associated with academic failure which may be due to examination pressure, assignment load as well as challenges of clinical practices. And self-esteem reflects a person’s overall subjective emotional evaluation of his or her own worth and is an important predictor of stress coping. Continuous high level of stress may influence learning process and self-esteem as well. The main objective of this study is to assess the academic stress and self-esteem among nursing students. Methods: A descriptive, cross sectional research design was adopted. Probability simple random sampling technique was used to select the sample which was 118 medical nursing students studying in the Yeti Health Science Academy, Kantimargh, Maharajgunj. Data was collected by using structured questionnaire including Student Academic Stress and Rosenberg self-esteem scale. Data analysis was done by descriptive statistic and inferential statistic with the help of (SPSS) version 20. (9). Results: Regarding the level of academic stress, about half of the respondents (50.8 %) had moderate academic stress followed by 31.4 % slight stress, 12.7 % high stress and 1.7 % extreme stress. And while assessing level of self-esteem, a majority of the respondents (83.9 %) had high self-esteem and 16.1 % had normal self-esteem. Conclusion: Based on findings academic stress in nursing students is about half of the Respondents. Therefore, intervention to reduce the academic stress should be carried out by identifying the causes of stress, stress reducing measures, counseling program and by developing a variety of skills to cope with negative aspects of stress so as to produce professionals who are confident, efficient and having clear vision about their future.
Introduction: The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. Abnormal knee kinematics in ACL deficient knee causes early osteoarthritis. Single bundle anatomical ACL reconstruction by medial portal technique provides better knee stability then transtibial technique. Many studies suggests that there is no difference in outcome of ACL reconstruction using hamstring or bone patellar tendon autograft. In this study we evaluated functional outcome (based on mean Lysholm score) at 6 month of single bundle ACL reconstruction by medial portal technique using bone patellar tendon bone or quadruple hamstring graft Methods: This was a prospective longitudinal study on functional outcome (using Lysholm score) of 75 patients who underwent single bundle anatomical ACL reconstruction by medial portal technique by using either quadruple graft hamstring or bone patellar tendon bone graft in sports and arthroplasty unit in Tribhuvan University teaching hospital, Kathmandu, Nepal between March 2014 to February 2016. Mean Pre op and 6 months post op Lysholm score of two groups was compared using paired-t test to evaluate the functional outcome of the surgery. Results: In this study overall mean pre op Lysholm score was 48.48±6.50 (36-62) and 6 months post op Lysholm knee score was91.58±3.10 (85-95), with p value 0.0000. The mean pre op and post op Lysholm score for Quadruple hamstring group was 47.7 and 91.5 respectively, while that for bone patellar tendon bone group was 54 and 91.7. Conclusion: The functional outcome (based on mean Lysholm score) at 6 months post op of single bundle anatomical ACL reconstruction was similar irrespective of type of graft used.
Introduction: Cancer is today’s burning healthcare issue. Disease itself as well as side effects from treatment has massive impact on patients’ lives. Tragic disease consequences happen, further worsened by inevitable adverse reactions of treatment. This study attempts to measure the various impact of disease among Nepalese cancer patients and their caretakers. Methods: This was a hospital based descriptive cross sectional study conducted in Bhaktapur Cancer Hospital for two months on l98 adult cancer patients and 20 caretakers. Face to face interview was done with semi structured interview schedule, 0-10 Numeric Pain Intensity Scale, Kuppuswamy’s Socioeconomic Status Scale and Beck’s Depression Inventory. Data entry and analysis was done on IBM SPSS V20. Results: Disease was seen in advanced age group with no sex wise variations. Majority was married, literate, from rural area, of upper caste and upper lower socioeconomic status. Cancer of lung, rectum and bile duct were more frequent in male in contrary to that of breast, ovary and cervix in female. Majority suffered from various impact of disease and side effects of the treatment like pain, depression, fatigue, weight loss, diminished physical activity and financial burden. Family members were equally prone to depression. Conclusion: Patients and their families are cosufferers in the battle against cancer. To confront the mounting impact of cancer epidemic in Nepal, cancer should be given high priority in national health programs, and population based cancer registry should be immediately established.
