INTRODUCTION Proximal Femoral Fracture (PFF), commonly seen in elderly osteoporotic patients, poses difficulties in achieving and maintaining stable fixation. Surgical treatment is essential because of limited role of conservative management. Use of Proximal Femoral Nail (PFN) for these fracture management has advantage of early mobilization, minimum blood loss, minimal infection and malunion rate. MATERIAL AND METHODS A prospective observational study was conducted among 50 patients in Orthopedics department at Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from April 2024 to October 2025. Selected patients with PFF were treated with PFN and they were followed post operatively at 6 weeks, 3 months and 6 months. At 6 months, Functional outcomes were assessed by using Kyle’s criteria. RESULTS Among 50 patients, most fractures were AO/OTA 31-A3 (50%) and Boyd–Griffin type III (42%). In 86% of cases, short PFN was used. The average duration to surgery was 3.12 days and the mean Tip Apex Distance (TAD) difference was of 1.44 mm. The average duration of fracture union was 10.56 weeks. Complications were minimal with lateral migration of screw among 8% cases. At 6 months, 98% of patient had excellent to good functional outcomes. Neck shaft angle was well maintained during 6 month follow up and the agreement was statistically significant (p<0.05), however no significant association was observed between fracture type and functional outcome. CONCLUSION Proximal femoral nail is an effective surgical treatment method for PFF with excellent functional outcome and minimal complication. Early postoperative neck shaft alignment strongly predicts long-term angular stability, while fracture classification does not significantly influence functional recovery.
INTRODUCTION Low birth weight (LBW) infants are the high risk conditions with the association of hypothermia, respiratory instability, bradycardia or tachycardia, poor weight gain which directly relates with the low health status. Kangaroo Mother Care (KMC) care is the skin to skin contact between mother and child promoting attachment, bonding breastfeeding which is cost-effective, accessible and non-invasive method benefiting the regulation of physiological parameters in infants. This study aimed to determine the effectiveness of KMC on stabilizing major physiological parameters of LBW infants admitted at National Medical College, Birgunj. MATERIAL AND METHODS A descriptive pre–post interventional study was conducted on 150 medically stable LBW infants eligible for KMC. Infants received 1–2 hours of KMC per session in a designated mother-infant KMC corner under trained supervision. Physiological parameters including temperature, heart rate, respiratory rate, oxygen saturation, and weight were recorded immediately before and after KMC. Data were analyzed descriptively to determine the proportion of infants showing improvement, no change, or deterioration in each parameter. RESULTSKMC led to substantial improvement across all physiological parameters. Improve in temperature was seen in 88% of infants, heart rate in 82%, respiratory rate in 78%, oxygen saturation in 94%, and weight in 100% infants. No deterioration was observed in any parameters. The intervention promoted thermoregulation, cardio-respiratory stability, and weight gain, highlighting the holistic benefits of KMC for LBW infants. CONCLUSIONKangaroo Mother Care is a safe, effective, and feasible method for improving physiological stability in LBW infants. Its routine implementation in neonatal care can enhance growth, reduce morbidity, and support optimal neonatal outcomes, particularly in resource-limited settings.
INTRODUCTION Unlike in adults, clinical scoring system to predict outcome and treatment response in pediatric status epilepticus is lacking. We used a pediatric modification of adult scoring system, Status epilepticus in pediatric patients severity score (STEPSS) to determine if it can accurately predict short term outcome. MATERIAL AND METHODS In this prospective study, children aged 1 to 18 years with seizure duration of ≥ 5 minutes or actively convulsing at emergency room were enrolled. STEPSS score was calculated at admission and outcome such as mortality, Pediatric overall performance category (POPC) at discharge and treatment response were noted. The diagnostic utility of STEPSS score to predict unfavorable outcome was calculated. RESULTS One hundred and twenty-five children with mean age 5.1 years were enrolled. Seven children died and 29 had unfavorable outcome. The predictive accuracy of STEPSS at cutoff >3 for mortality had sensitivity of 85.3, specificity of 60.2 and negative predictive value of 98.6 with area under curve 0.751 [ 95% CI: 0.593-0.908]). Likewise, it predicted unfavorable outcome with sensitivity of 51.7, specificity of 60.4 and negative predictive value of 80.6. CONCLUSION The STEPSS, a simple bedside clinic score was found to be valuable in predicting outcome and treatment response in children with status epilepticus.
INTRODUCTION A flatfoot is common during childhood and is regarded as a part of normal foot development. Nevertheless, the persistence of flatfoot beyond early childhood may affect the biomechanics of lower limb, causing discomfort and pain. Although increased body weight has been identified as a potential contributing factor, evidence from Nepal remains limited. The study aims to determine the prevalence of flatfoot among children aged 6-10 years and assess its association with body mass index (BMI). MATERIAL AND METHODS A cross-sectional study was carried out among 361 children aged 6–10 years from selected schools in Ward 10 of Suryabinayak Municipality, Bhaktapur. Participants were recruited using a multistage cluster sampling technique. Body mass index was calculated and categorized using Centers for Disease Control and Prevention (CDC) age- and sex-specific percentiles. Flat foot was assessed from inked footprints using Staheli’s plantar arch index. Associations between flatfoot and demographic variables were analyzed using Chi-square test. A p-value of <0.05 was considered statistically significant. RESULTS The overall prevalence of flatfoot was 18.8%. Flatfoot was significantly associated with age (p< 0.05) and body mass index (p<0.05), with prevalence decreasing with increasing age and increasing across body mass index categories. Although flatfoot was more common in boys than girls, the association was not statistically significant (p = 0.096). CONCLUSION The prevalence of flatfoot is relatively high in primary school-aged children and is positively associated with body mass index. Promoting foot health screenings and healthy weight maintenance may help reducepotential biomechanical consequences of flatfoot.
INTRODUCTION The acronym ESKAPE is used to describe six nosocomial pathogens that exhibit virulence and multidrug resistance, which includes: Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecium, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. Among MDR pathogens, ESKAPE pathogens have caused a major concern due to their resistance against antibiotics and other medicine resulting in worse patient outcomes and increased treatment costs. MATERIAL AND METHODS A retrospective cross-sectional study was conducted at microbiology laboratory of a tertiary care hospital, Nepal. A total of 6583 samples were processed following standard microbiological procedures. Standard microbiological techniques were used for isolation and identification of pathogens and antibiotic susceptibility test was performed as per clinical and laboratory standard institute (CLSI) guidelines. Phenotypic detection of multidrug resistance (MDR), methicillin resistant Staphylococcus aureus (MRSA), and vancomycin resistant Enterococcus faecium (VRE) was performed. RESULTS During the period, a total of 1583 (24.05%) ESKAPE pathogens were identified. Amongst gram negative ESKAPE pathogens, multidrug resistant (MDR) were more predominant in Acinetobacter baumannii (67.70%) followed by Klebsiella pneumoniae (65.59%), Enterobacter species (49.36%), Pseudomonas aeruginosa (46.78%). Similarly, in gram positive ESKAPE pathogens, MDR was found to be Staphylococcus aureus (65.35%), and Enterococcus faecium (69.23%). MRSA was found to be 42.51% (n=54) and VRE 3.08% (n=2). CONCLUSION Due to increasing burden of MDR ESKAPE pathogens in hospital settings, periodic surveillance of resistant bacteria in hospital settings is strongly recommended to minimize the problem by formulating the antibiotic policy and antibiotic stewardship program.
