Introduction: A thorough grasp of possible anatomical variations is crucial for successful root canal treatment. An example of such a variation is the C-shaped canal morphology, primarily observed in mandibular second molars. This morphology is distinguished by a cross-sectional configuration resembling the letter “C.” Objective: This study aimed to assess the prevalence of C-shaped canals in permanent mandibular second molars among patients attending a tertiary care hospital in Nepal, utilizing cone-beam computed tomography (CBCT). Methodology: This descriptive cross-sectional study was conducted at the Department of Conservative Dentistry and Endodontics, Kathmandu University School of Medical Sciences (KUSMS) - Dhulikhel Hospital, Nepal, from December 2020 to November 2021. Ethical approval was obtained from the Institutional Review Committee of KUSMS prior to the study. CBCT scans of 150 mandibular second molars were evaluated by two endodontists. The study assessed tooth position (right or left side), prevalence of C-shaped canals, classification of C-shaped canal configurations at the orifice cross-sectional level, and the occurrence of C-shaped canals unilaterally or bilaterally. Data were analyzed using SPSS. Results: Out of the 150 teeth examined, 13 (8.7%) teeth exhibited a C-shaped root canal system. Among these 13 teeth, 7 (53.8%) teeth had an uninterrupted “C” configuration at the orifice level. Conclusions: This study found a notable prevalence of C-shaped root canals in mandibular second molars among the Nepalese population sampled.
Introduction: Ethambutol is an important and widely used drug in the treatment of both tubercular and non-tubercular mycobacterial disease as it is the least toxic of the first line antituberculosis drugs. The main disadvantage of this drug is its associated ocular toxicity, manifesting as optic neuropathy. Objectives: To describe the demography, risk factors and visual function in Ethambutol induced Optic Neuropathy (EON) among patients presenting at a tertiary eye centre in Nepal. Methodology: This retrospective study was conducted at B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, where all consecutive patients with ethambutol induced optic neuropathy presenting from 1st April 2022 to 30th March 2024 were recorded. Parameters recorded were patient demographics (age, gender and ethnicity), presenting complaints, duration and dosages of ethambutol, body weight, visual acuity, colour vision, contrast sensitivity and visual field. Results: There were 14 patients (28 eyes) of ethambutol induced optic neuropathy. The mean age of patients taking ethambutol was 50.64± 15.8 years with mean daily dose of 18.27 ± 2.29 mg/kg per day. Bilateral ocular involvement was seen with visual acuity ranging from CFCF to 20/60 in one or both eyes. The most common color vision defect was nonspecific defect seen in six patients. The most common visual field defect was centrocecal scotoma in six cases. Mean contrast sensitivity was 1.50±0.32 log units. Thinning of the RNFL and GCC were seen in all cases of EON and the thinning correlated with the severity of visual loss. Conclusions: EON was seen at a mean dose of 18.27mg/kg and mean duration of 7.25 months with moderate to severe visual loss and decrease in contrast sensitivity and visual field defects. Average RNFL thinning and GCC thinning correlated with the severity of visual loss seen in EON subjects. Awareness and early diagnosis can help reduce the unnecessary blindness due to this condition in the susceptible group.
Introduction: Long COVID is described as signs and symptoms that continue or develop after acute COVID-19. In most cases, long COVID symptoms resolve within 1-5 months. Long‐term health sequels of the COVID‐19 are a major public health concern. However, evidence on post‐acute COVID‐19 syndrome is still limited, particularly for children and adolescents. Objectives: To investigate the prevalence, symptoms, duration and risk factors of long COVID. Methodology: A prospective, observational, longitudinal study was done in BMCTH, a tertiary care centre. Sixty children up to the age of 14-year, diagnosed as COVID-19 by RT-PCR and antibody were included. Follow-up of children were done within 1-3 months and 3-5 months after the treatment of acute COVID-19. Symptoms and duration of symptoms were noted on follow-up after the treatment of acute COVID-19. Results: Out of 60 children, 45 (75%) children were followed within 1-3 months and 3-5 months. Among them, 14 (31.11%) developed long-COVID symptoms. Long COVID symptoms were common in children of one year 5 (33.33%) with predominance of male 9 (36%) compared to female children 5 (25%).The long COVID symptoms were mostly respiratory and neuropsychiatric like cough 7 (50%), difficulty in breathing 5 (35.71%), fever 3 (21.43%), headache 2 (4.28%) fatigue2 (14.28%), Chest/ abdomen pain 2 (14.28%), loss of appetite 1 (7.28%). Severity of acute COVID-19 and multisystem inflammatory syndrome in children were risk factors for long COVID. The symptoms subsided mostly within 3 months. Conclusion: Thirty-one percent hospitalized children developed long COVID; mostly respiratory and neuropsychiatric symptoms. Long COVID symptoms subsided within three months after treatment.
Introduction: Excision of the radial head was frequently indicated in the past, as the radial head was considered to have a minimal role in the stability and biomechanics of the elbow. Now, it has been established that the radial head has an important role, and its removal has shown to alter the stability and biomechanics, due to which surgeons are motivated to preserve or replace the radial head during fracture management. Objectives: This study aims to study the short-term clinical outcome and patient satisfaction of radial head replacement with prosthesis. Methodology: This study was conducted among patients who underwent radial head arthroplasty. A study tool was prepared for data collection, and the data was refined in Excel and analyzed using SPSS 20. Outcomes were assessed by using different parameters like range of motion, mayo elbow performance score, time to return to work, patient satisfaction, and complications. Results: This study had sixteen participants with a mean age of 40.19 ± 11.391 and a male-to-female ratio of 3:1. Mayo Elbow Performance Scores (MEPS) had a median (IQR) score of 85 (80-96.25). The median for extension was 5°, for flexion was 140°, and for both pronation and supination was 80°. The median time taken for return to work was two months, and 12.5% of the patients reported being dissatisfied. Conclusion: Radial head arthroplasty preserves the elbow stability and reestablishes normal functioning of the elbow after radial head fracture Mason type III.
Introduction: Maternal healthcare is a crucial to public health and despite notable improvements in Nepal’s access to utilization of maternal healthcare, disparities persist based on social understanding. This study aims to identify the factors influencing women’s decisions to deliver at tertiary care hospitals. Objective: The objective was to investigate the decision making factors among women’s delivering for childbirth at tertiary care hospital in the eastern part of Nepal. Methodology: This descriptive prospective cross -sectional study was conducted from November to December 2023 at Department of Obstetrics and Gynecology, Birat medical college Teaching Hospital. The study involved mothers aged 20-25 fulfilling inclusion criteria and data was collected through face-to-face interviews using a self-structured proforma, ensuring privacy and comfort. Mothers sociodemographic data and responses from the questionnaire was entered in excel sheet and calculation done by SPSS. Results: In 275 pregnant mothers, with mean age of 25.32 ± 4.54 years, majority (65.8%) resided more than an hour away from the hospital. Notably, (80.7%) were first-time hospital users. Family members primarily made the decision for hospital deliveries (65.1%). Most women(89.4%) found the reception staff approachable,99.6% reported easy access to doctors, 94.9% experienced short waiting times, and 98.9% praised the cleanliness of hospital facilities. All respondents felt respected by doctors (100%), and nearly all (99.3%) believed doctors allocated sufficient consultation time. Conclusion: The study highlight high levels of satisfaction with the care provided at the tertiary care hospital, despite challenges such as distance which reflects trust in the hospitals services.
Introduction: Mobile phones are an often-overlooked source of microbial contamination in healthcare settings and pose a serious risk for the spread of hospital-acquired infection. Objectives: The objective of this study was to isolate the aerobic gram-positive cocci and gram-negative bacilli and their antibiotic susceptibility pattern from healthcare workers' mobile phones in a hospital. Methodology: The hospital-based descriptive cross-sectional study was conducted in the Clinical Microbiology Laboratory of Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from May 2024 to October 2024. Identification of pathogenic aerobic gram-positive cocci and gram-negative bacilli from mobile phones of healthcare workers (HCW) was done by standard protocol, and antimicrobial susceptibility testing was done by Kirby- Bauer disc diffusion method following Clinical Laboratory Standard Institute guidelines. Results: A total of 215 (100%) swab samples were collected from healthcare workers' mobile phones, 152 (70.6%) samples showed significant bacterial growth by culture, and 63 (29.3%) mobile phone samples showed no growth. The most common organisms isolated were Staphylococcus aureus, followed by Escherichia coli and coagulase-negative Staphylococcus (CONS). All the gram-positive cocci were sensitive to linezolid, teicoplanin, and vancomycin, and gram-negative aerobic bacteria other than Pseudomonas were sensitive to gentamycin, cephalosporins, and Extended-Spectrum Beta-Lactamase (ESBL) producing gram-negative aerobes were sensitive to meropenem, piperacillin/tazobactam and cefepime. Conclusion: The present study highlights that healthcare workers' mobile phones carry pathogenic organisms, the most common in our setting was Staphylococcus aureus. This study also showed that gram-positive cocci were sensitive to linezolid, teicoplanin, and vancomycin, and gram-negative aerobic bacilli other than Pseudomonas were sensitive to gentamycin, cephalosporins, and ExtendedSpectrum Beta-Lactamase (ESBL) producing gram-negative aerobes were sensitive to meropenem, piperacillin/tazobactam and cefepime.
Introduction: Postpartum hemorrhage is the leading cause of maternal mortality worldwide, especially in resource-limited settings like Nepal. Simulation-based training is a proven educational approach that equips healthcare providers with the critical knowledge and skills necessary to manage postpartum hemorrhage effectively. Objectives: The objective was to evaluate the effectiveness of simulation-based training on Helping Mothers Survive: Bleeding After Birth in strengthening healthcare providers’ competencies in managing PPH and shock in a tertiary hospital in eastern Nepal. Methodology: A simulation-based educational intervention was conducted in two phases: first phase took place on 26-27th June, 2023 and the second on 3-4th January, 2024, among 44 healthcare professionals. Helping Mothers Survive standardized assessment tools were used for Pre-test and Post-test knowledge on postpartum hemorrhage, and shock management and skill evaluations in Active Management of Third Stage of Labour, atony, bimanual compression, and condom tamponade, and shock management. Data were analyzed using paired t-tests in SPSS version 23, with p < 0.05 considered significant. Results: Among 44 healthcare professionals the mean knowledge scores for postpartum hemorrhage and shock management improved significantly from 11.77 ± 1.89 to 14.0 ± 1.01 (p < 0.001) and 4.27 ± 1.32 to 7.38 ± 0.56 (p < 0.001) respectively. OSCE results showed that all participants passed Active Management of Third Stage of Labour L and shock management. Forty-two out of 44 participants (95.45%) successfully performed atony management, bimanual compression, and condom tamponade. Conclusion: Simulation-based education significantly improved knowledge and skills among healthcare professionals working in maternity units. However, two participants who fell short highlight the need for frequent, ongoing training.
Introduction: Anxiety is a common problem experienced by patients with chronic kidney failure undergoing hemodialysis therapy. Hemodialysis can be a challenging experience for patients, often leading to psychological distress, including anxiety which may vary from mild, moderate, severe to panic. Objectives: To find out the prevalence of anxiety among hemodialysis patient and its association with selected socio-demographic and clinical variables. Methodology: The study used a descriptive cross-sectional research design. A total, 108 hemodialysis patients were chosen using a non-probability purposive sampling method. Anxiety symptoms were assessed using Hamilton Anxiety Rating Scale. Data was collected using face-to-face interview method. SPSS version 20 was used for data analysis. Results: The mean age of the participants was 48.44 years ranging from 20 to 81 years. More than one-third (38.9%) of the participants belonged to the age group 45-59 years. More than half (54.6%) were females. About one-third had mild anxiety symptoms. Hemodialysis duration showed significant (p<0.05) association with anxiety. Conclusion: The study concluded that nearly one fourth of the respondents had no anxiety symptoms whereas about one-third had mild anxiety symptoms. Likewise, one-fourth of the respondents had severe anxiety symptoms. Hence, psychosocial counselling and collaborative treatment approach is needed to reduce the anxiety symptoms among the hemodialysis patient.
Introduction: Vision is a fundamental component of safe driving. Any significant loss of visual function such as vision, field of vision, color vision, or contrast sensitivity/ability to see light and traffic signals in bad weather and night will diminish a person’s ability to operate a motor vehicle safely on today’s congested high-speed roadways. Objectives: To find out the pattern of ocular and ear morbidity of city rickshaw driver of Biratnagar metropolitan city. Methodology: The descriptive cross-sectional study was conducted at Biratnagar Eye Hospital (BEH), Biratnagar. The socio-demographic variables, assessment of uncorrected and corrected visual acuity for distance and near, color vision, stereopsis/depth perception, anterior and posterior segment ocular examination was done. Ear examination was performed by using otoscope and torch light. Results: Among 154 participants, mean age (±SD) was 38.09(±9.66) and all of them were male 154(100%). Nearly half 74(48%) of the participants were in the age group 26-40 years among them majority had completed secondary level education 94(61%) and 121(78.6%) had no driving license. More than half of the participants 79 (51.3%) reported previous history of eye examination. Normal color vision and stereopsis was found in 142(92.2%) and 89(57.8%) participants respectively. Majority of them 306(99.35%) had normal best corrected visual acuity. Only 2 of them had history of Road Traffic Accident (RTA). More than two-thirds of the participants had no ear morbidity. Conclusion: Distance visual acuity was found good but presbyopia was the most common ocular morbidity and stereopsis was found abnormal among electric rickshaw driver. Majority of them had no ear morbidity
Introduction: Stroke causes neurological dysfunction by cerebral or spinal infarction. Ultrasound of the carotid arteries is beneficial for the management of carotid atherosclerosis. Multiple risk factors exist for the occurrence of large artery stroke. Methodology: This prospective descriptive study was conducted in a tertiary Care Centre from March 2023 to March 2024. Ethical clearance was taken from the Institutional Review Committee (Ref no: 816/2023). Purposive sampling was used to include 204 patients with stroke/transient ischemic attacks. Variables collected were demographics, evaluation of comorbidities, previous medical history, family history, and carotid ultrasound including grayscale and color Doppler. Results: The mean age of the patients was 68.39 ± 9.35 years with a male predominance. Carotid plaques were seen in 91.67%. The most common artery was the left common carotid and the most common type of plaque was the heterogeneous type. Severe narrowing of the arteries was seen in 20.09% with complete occlusion in 8.33% and 8.82% of cases in the right and left internal carotid arteries respectively. Increasing age, hypertension, diabetes, dyslipidemia, smoking, and family history were important risk factors for the occurrence of stroke. A carotid intima-medial thickness of over 1 mm was observed in 40.68% and 35.76% of the right and left common carotid arteries, respectively. Conclusion: Carotid gray scale ultrasonography revealed significant carotid plaque status in patients of stroke. The presence of comorbidities increases the risk of stroke and carotid plaque. Color Doppler ultrasound of carotids is a useful tool for managing carotid atherosclerosis.
Introduction: Retinopathy of Prematurity (ROP) is a major cause of preventable blindness in preterm infants. This study aims to determine the incidence of ROP and associated risk factors in preterm infants in a tertiary care hospital in Nepal. Methods: A cross-sectional study was conducted over 18 months in NICU. Preterm infants with gestational age ≤34 weeks or birth weight ≤2000 grams were screened for ROP. Maternal and neonatal data were analysed to identify risk factors. Results: A total of 75 preterm infants were screened, with 19 (25.3%) diagnosed with ROP. Infants with ROP had significantly lower gestational ages (mean 30.52 ± 1.5 weeks) and birth weights (mean 1308.94 ± 288.98 grams) compared to those without ROP (mean gestational age 31.94 ± 1.74 weeks, mean birth weight 1646.25 ± 432.29 grams). Prolonged duration of supplemental oxygen (mean 13.47 ± 4.77 days in the ROP group) was also significantly associated with ROP (p=0.001). Mode of delivery was a significant factor, with caesarean delivery more frequent among ROP cases (p=0.016). Other factors, such as APGAR scores, neonatal jaundice, and neonatal sepsis, showed no significant association with ROP. Conclusion: The incidence of ROP was 25.3% with low gestational age, birth weight, and prolonged oxygen use as key risk factors. Early screening is essential for timely intervention in Nepal.
Introduction: Nasotracheal intubation (NTI) is a widely used technique in maxillofacial and oral cavity surgeries to provide better surgical access. Conventional NTI, while effective, is associated with complications such as nasal bleeding and oral cavity trauma. The bougie-assisted NTI technique, combined with video laryngoscopy, has been proposed to improve the success rate of firstattempt intubations and reduce trauma and other complications. Objectives: The study aimed to evaluate the effectiveness and safety of the bougie-assisted NTI technique, focusing on the success rates of first and second intubation attempts, time required for intubation, hemodynamic changes, and incidence of complications like nasal bleeding and mucosal injury. Methodology: This prospective observational study was conducted at Nepal Medical College from February 2024 to July 2024. A total of 36 patients, aged 18 years or older, scheduled for elective maxillofacial and oral cavity surgeries were included. The bougie-assisted technique was adopted under general anesthesia, and video laryngoscopy was employed for visualization. Hemodynamic parameters and complications were recorded at predefined intervals. Data were analyzed using descriptive statistics. Results: Among 36 patients who underwent nasal intubation, 28 patients (77.8%) were successfully intubated on the first attempt, and 8 patients (22.2%) required a second attempt, There were no cases of esophageal intubation, or oral cavity injury. The incidence and severity of nasopharyngeal trauma was significantly decreased. The heart rate, systolic blood pressure, have no significant change (p< 0.05), But the diastolic blood pressure increase in 10,and 15 minutes was significant (P > 0.05) in pre-intubation and post-intubation hemodynamic. The aim of the study was bougie-assisted technique would result less hemodynamic change, easy to intubate, less time required to intubate without nasopharyngeal trauma. Conclusion: Bougie assisted technique for nasotracheal intubation increases the rate of success on first attempt while reducing complications such as nasal or oral trauma and epistaxis. Therefore, we recommend using the bougie assisted technique for nasal intubation.
Introduction: Ureteral stones often require pharmacological intervention to aid their passage. Alpha-blockers like Alfuzosin and Silodosin are frequently used to relax ureteral smooth muscle and facilitate stone expulsion. Objectives: The objective of this study was to compare the efficacy of 10 mg Alfuzosin and 8 mg Silodosin in facilitating the passage of small ureteral stones (≤10 mm), with a focus on stone expulsion time. Methodology: The study was conducted at Birat Medical College Teaching Hospital, Nepal from December 25, 2023, to June 24, 2024. A total of 116 patients, aged 18 to 50, with unilateral, uncomplicated stones in the middle or lower ureter, were randomly assigned to receive either 10 mg Alfuzosin (Group A) or 8 mg Silodosin (Group B). Patients were monitored weekly for three weeks, and stone passage was tracked. If the stone was not passed by day 21, treatment was considered a failure. Results: The mean age of patients was 37.5 years in both groups. In Group A, 48 out of 58 patients (82.8%) passed their stones, while in Group B, 53 out of 58 patients (91.4%) succeeded in passing their stones. The difference in success rates was not statistically significant (p = 0.166). However, Silodosin led to faster stone expulsion compared to Alfuzosin. Conclusion: Both Alfuzosin and Silodosin were effective in promoting stone passage, with success rates of 82.8% and 91.4%, respectively. While Silodosin showed a higher success rate, the difference was not statistically significant. Silodosin also appeared to facilitate faster stone expulsion, suggesting it may be a slightly more effective option for stone management.
Introduction: Fine needle aspiration cytology is a well-established, rapid, safe and cost-effective diagnostic technique and is increasing in popularity to diagnose mass lesions in intra-abdominal organs. Deep-seated organs are safely sampled and routinely aspirated using the fine needle under radiological guidance. Objective: To diagnose intra-abdominal masses using ultrasound-guided fine needle aspiration cytology and to categorize them as malignant, benign, suspicious, inflammatory, and unsatisfactory according to organ-wise. Methodology: This was a hospital-based prospective cross-sectional study carried out in Birat Medical College Teaching Hospital, where 77 cases were included in which FNAC was done for intra-abdominal masses under ultrasound guidance. Air dried smears were prepared for Giemsa stain and wet smears were prepared for PAP stain. The smears were classified as unsatisfactory, inflammatory, benign, malignant, and suspicious for interpretation categories. Results: A total of 77 patients with intra-abdominal lesions were included in this study. The patient age ranged from 13 to 90 years, out of which 37 cases (48.1%) were males and 40 cases (51.9%) were females. Out of the total 77 cases, 76.6% of cases were reported to be malignant followed by 9.1% inflammatory, 6.5% suspicious, 5.2% inadequate and 2.6% benign. The liver was the most common site for FNAC comprising 35 (45.5%) cases. Conclusions: In cases of intra-abdominal masses, the most common site for FNAC was the liver. Similarly, the most common cytological findings were malignant cases, followed by inflammatory, suspicious, unsatisfactory, and benign cases.
Introduction: Use of ropivacaine alone in brachial plexus block can provide dense anaesthesia of upper limb for shorter duration and have shorter period of postoperative analgesia. However, many drugs are being used as an adjuvant to local anaesthetic to enhance onset, efficacy and duration of anaesthesia and postoperative analgesia. Objectives: The main objective of our study is to assess the efficacy of dexmedetomidine as an adjuvant to ropivacaine for supraclavicular brachial plexus block. Methodology: This is a prospective comparative study conducted on 60 patients aged between 18 to 65 years undergoing below elbow upper limb surgery under brachial plexus block. Patients were equally divided into two groups. Group R patients received 25 ml of 0.5% ropivacaine with normal saline (2 ml) whereas Group D patients received 25 ml of 0.5% ropivacaine with 1mcg/kg dexmedetomidine (2 ml). The time of onset and duration of sensory and motor block and duration of analgesia were compared among groups. Results: Demographic variables were comparable in both groups. There was faster onset and longer duration of sensory and motor block in group D than that in group R. Duration of analgesia was shorter in group R compared to group D. Conclusion: Use of dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block hastens the time to onset and prolongs the duration of anaesthesia and postoperative analgesia.
Introduction: The purpose of this study was to determine whether dexmedetomidine as an adjuvant to ropivacaine in brachial plexus improves the quality of block in terms of onset, duration of analgesia and assess complications of dexmedetomidine. Objectives: To evaluate the effect of dexmedetomidine as an adjuvant to ropivacaine for brachial plexus block in upper limb surgery To assess onset of sensory and motor blockade, duration of sensory and motor blockade, duration of analgesia and any adverse effects of dexmedetomidine. Methodology: 80 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing upper limb surgery under brachial plexus block were randomly divided into two groups. Group R received 0.35% ropivacaine, 1.5% xylocaine with adrenaline (30ml) and Group RD received 0.35% ropivacaine, 1.5% xylocaine with adrenaline and dexmedetomidine (30ml). Results: The onset of both sensory and motor block was earlier in Group RD than Group R. They were clinically significant (p value 0.000 for sensory, p value 0.005 for motor). The duration of both sensory and motor block was longer in Group RD than Group R which was statistically significant (p value 0.000 for duration of sensory block, p value 0.000 for duration of motor block). Duration of analgesia was also longer in dexmeditomidine group (p value 0.000). Conclusions: Dexmedetomidine (1mcg/kg) as adjuvant to ropivacaine in brachial plexus block shortens the onset of (sensory and motor) block, prolongs the duration of (sensory and motor) block and duration of analgesia.
Introduction: Laparoscopic cholecystectomy stands as one of the most commonly performed surgical procedures worldwide, primarily indicated for symptomatic cholelithiasis and associated gallbladder diseases. Despite its minimally invasive nature, concerns persist regarding the risk of postoperative infections, which can significantly impact patient outcomes and healthcare costs. Antibiotic prophylaxis has long been considered a standard practice to mitigate this risk, yet the optimal approach remains a subject of debate. Objective: This research was aimed to elucidate the comparative effectiveness of preoperative prophylactic antibiotic versus no antibiotics in patients undergoing elective laparoscopic cholecystectomy. Methodology: We conducted a prospective comparative study at xxxxxxxxxxxx from 27 November 2023 to 27 February 2024. A total of 200 patients undergoing elective laparoscopic cholecystectomy were enrolled consecutively and assigned to the no antibiotic prophylaxis group and single dose preoperative antibiotic prophylaxis group (SD) on a roll basis. The SD group received a preoperative injection of ceftriaxone (third generation of cephalosporin) (1gm) 30 minutes before the surgical procedure. Data were collected and analyzed using SPSS version 23. Results: The overall rate of SSI was 4% in our study. Five out of 100 patients who received prophylactic and 3 out of 100 patients who did not receive antibiotics developed surgical site infection(SSI). However, the difference was not statistically significant. Reviewer recommendation: Few lines of important characteristic of disease profile (like % stented GSD, of empyema, complicated GSD etc) which has high risk of SSI should have been mentioned in results for better interpretation of results in abstract is recommended) Conclusion: Our study comparing preoperative prophylactic antibiotics versus no antibiotics in elective laparoscopic cholecystectomy patients reveals no significant association between antibiotic use and outcomes such as surgical site infections and fever.
Introduction: Paediatric trauma is a leading cause of disability, hospitalization and may lead to mortality in pediatric population. Incidence and nature of fracture varies according to region, culture, seasonal variations and age. Children are more prone to have injury at play grounds, due to fall from height and also due to road traffic accident due to unmanaged traffic and lack of road safety measures. Identification of specific high-risk injury patterns may lead to improved care and outcome. This study aims to find out the epidemiological profile of paediatric injuries presenting to a tertiary care hospital in eastern Nepal. Objective: To study the common fractures and their management in the paediatric age group at Koshi hospital. Methodology: This was a hospital based retrospective cross-sectional study done among 424 paediatric patients at Koshi hospital from January 2021 to December 2021.Ethical clearance was taken from Nepal health research council . Data collection was done from the outpatient (OPD), emergency and the operation room records and was compiled in Microsoft excel 2007. Results: A total of 424 paediatric fractures were taken into study over the duration of one year. Out of which 288 were male (67.92%) and 136(32.08%) were female. Playground injuries were the most common cause of paediatric fractures (49.76%) followed by fall from height (27.35%) and road traffic accident (12.26%). Distal radius and ulna fracture was found to be most common (30.89%). Conclusion: Distal radius and ulna is the commonly fractured bone followed by supracondylar fractures of the humerus. Most of the paediatric fractures can be managed conservatively. Supervised play in the grounds, at home and at schools are important because paediatric injuries most of the times can be prevented to decrease the morbidity and mortality in the paediatric population. Proper knowledge and awareness of the traffic rules and zebra crossings should be implemented with local community participation and cooperation.
Introduction: Breast cancer is the most common cancer in Nepal. Treatment of breast cancer includes combined therapy based on hormonal receptors within breast tissue and is linked to prognosis and survival. Objective: To evaluate hormonal factors preoperatively and assess the impact of how it would change the management practices of treating breast cancer in our setup. Methodology: This descriptive prospective study was conducted from March to October 2023 in the department of surgical oncology BMCTH in patients with breast mass suggestive of carcinoma meeting inclusion criteria and willing for treatment. Patients demographic data, detailed history and clinical examination was done at the time of diagnosis entered in excel sheet and calculation done by SPSS. Ethical clearance was taken from the institutional review committee of BMCTH (Ref: IRC-PA-296/2023 ). Results: In 80 female patients with mean age 46.15 years, Left breast cancer (60%) was more common than right side (40 %). Most common site of presentation was the upper outer quadrant (UOQ- 47.%). Invasive ductal carcinoma was the commonest type (47.5%) of all histological variants. 67.5% patients had ER positive receptor, 67.5% had PR positive and 2 Her2 neu was present in 28.7 %. TNBC reported 18.75% (15 patients out of 80 patients). Ki- 67 prognostic value ranged from 10 to 70 with mean 29.91+-20.795%. Among all 36.3% underwent neoadjuvant chemotherapy prior to surgery and 63.7% underwent upfront surgery for breast cancer. Conclusion: Screening of Triple negative and luminal type B breast cancers preoperatively is essential. Evaluation of hormonal factors ER, PR, Her 2 neu and Ki-67 preoperatively is must as it changes the management practices of treating breast cancer.
