Introduction: This longitudinal, prospective, descriptive study was carried out to find out frequency and types of fungal rhinosinusitis, clinicopathologic features,its association with systemic disease and outcome of treatment. Method: Patients who underwent endoscopic sinus surgery and fulfilled any of the following two criteria were included in the study: unilateral sinonasal polyps, CT Scan showing soft tissue density with hyperdense areas, presence of fungal mucin or mud during surgery, histopathological report showing fungal infection. Surgical specimens were sent for KOH preparation, fungal culture and histopathological analysis. Results: Out of 284 patients of chronic rhinosinusitis, 41(14.44%) patients had fungal rhinosinusitis, allergic fungal rhinosinusitis (40) and acute fulminantinvasive fungal rhinosinusitis (1). Age ranged from 14-63 years, 26 males and 15 females. Sixteen patients had unilateral disease. The common symptoms were nasal obstruction (41), decreased smell (24) and sneezing (21). Eight patients had hypertension, bronchial asthma (5), COPD(1), pulmonary tuberculosis (1), diabetes mellitus (2) of which 1 patient hadmucormycosis. All the patients had nasal polyps, 1 patient with mucormycosis also had mucopurulent,discharge from left middle meatus and diffuse swelling of left periorbital and maxillary area. Aspergillusfumigatus was isolated in 1 patient. Histopathological examination reported fungal polyp in 5 and mucormycosis in 1 patient. There is no recurrence till date. Conclusion: Fungal rhinosinusitis is a common pathological entity. It affects both genders common in age group of 21-60 years. It presents as bilateral as well as unilateral nasal polyps. Nasal obstruction is the most common symptom followed by decreased smell and sneezing. Seventeen patients had systemic disease. The treatment protocol used was effective.

Background: This study aims to assess anatomical variations in the frontal sinus and its drainage pathway within the Nepalese population. Methodology: This cross-sectional analytical study was conducted at the Department of ENT-HNS and Radiology, Maharajgunj Medical Campus in Nepal. Digital Imaging and Communications in Medicine (DICOM) computed tomography files of patients were analyzed over a year to assess pneumatization variations, frontal sinus size, presence of intersinus septa, olfactory fossa depth, frontal recess cells, and anterior ethmoidal artery position. Imaging files with obscuring disease processes or obtained in different positions, hindering frontal sinus or recess visibility, were excluded. Data analysis employed SPSS version 25, using descriptive statistics (median, range, interquartile range), Chi-squared tests, and Cramer’s V. Results: Among total sinuses analyzed, 7% exhibited unpneumatized frontal sinuses (3.3% bilaterally, 6.7% unilaterally). Median dimensions for right and left frontal sinuses were 10.2 x 11.15 x 11.7 mm and 10.2 x 11.1 x 11.6 mm, respectively. Predominant fin- dings included mixed upper uncinate process attachments, Type II olfactory fossa, agger nasi as the commonest anteriorly based cells, and supra bulla cells as the prevalent posteriorly based cells. Conclusion: Investigation of frontal sinus anatomy in the Nepalese population revealed distinct features. While generally well- developed, these sinuses exhibited relatively smaller dimensions compared to other ethnic groups. Consistent with prior studies, agger nasi and supra bulla cells were the most prevalent anteriorly and posteriorly based cells, respectively.

INTRODUCTION Previously, the ultrasound (USG) was the first choice in the evaluation of urinary tract calculus. In the past decade, developments in Computed Tomography (CT) technology have changed the trend of imaging modalities used in the evaluation of the urinary system. The present study was undertaken to compare USG and CT in the detection of urinary tract calculi. MATERIALS AND METHODS A prospective, cross-sectional, and observational research design was used. The study was conducted in the Department of Radiology of Tribhuvan University Teaching Hospital from July 2022 to October 2022 with 96 patients. Patients suspected of having urolithasis after performing USG underwent plain CT KUB. Both findings were compared on the basis of age, gender, and location. Specificity, sensitivity, positive predictive value, and negative predictive value of USG were calculated using CT as the gold standard. RESULTS Among them 58.33% were male and 41.66% were female in this study. The mean age among the males was 34 ±14.79 years, and the mean age among the females was 38 ± 18.74 years. On the CT scan, the majority of patients (80%) had renal calculi; 15.60% had calculi in VUJ; and 41.66% had calculi seen bilaterally. Out of 22 patients with ureteric calculi, 5 cases were seen in USG, and the sensitivity of USG in diagnosing ureteric calculi in comparison to CT was 22.72% with 100% specificity, PPV was 100%, and NPV was 81%. The result of CT was found to be statistically significant compared to USG RESULTS: at P<0.001. CONCLUSION CT was found to be highly sensitive and specific in the detection of urinary tract calculi in comparison to USG, which is critical for decision-making and patient counseling without further economic burden and degradation.

BACKGROUND: Impact of intranasal corticosteroid (INC) on intraocular pressure (IOP) has been a topic of longstanding debate with various studies showing variable results. This study aims to assess the effect of INC on IOP in the Nepalese population in a tertiary hospital of Nepal. METHODOLOGY: This was prospective observational study conducted in a tertiary hospital from May 2021 to November 2022. IOP of patients who met our inclusion criteria were measured before and after 6 weeks of the initiation of INC. Data were collected and compiled in Microsoft Excel. The statistical test was done using SPSS version 25. RESULTS: A total of 48 cases were evaluated. We observed that the mean IOP difference before and after nasal steroid usage exhibited no statistically significant variance: 0.5 mean IOP in the right eye and 0.12 mean IOP in the left eye. CONCLUSIONS: This study proposes that intranasal steroids pose a minimal risk of inducing ocular hypertension in the Nepalese population. Nonetheless, larger cohort studies with extended follow-up durations are warranted to substantiate these findings.

Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint. Objective To assess the prevalence of teenage pregnancy, associated risk factors, and outcomes in the context of Nepal. Method We searched electronic databases to search relevant articles published from January 2000 till October 2020 using the keywords with appropriate Boolean operators. All the data were extracted into a standardized form designed in Excel. We conducted a statistical analysis using Comprehensive Meta-Analysis Software (CMA) version 3. Data pooled for proportion with 95% confidence interval (CI). A Forest plot was used to visualize the degree of variation between studies. Result Fourteen studies were included in the analysis after the rigorous screening of 4425 studies. Prevalence of teenage pregnancy was 13.2% (Proportion, 0.132; CI, 0.077- 0.215). Among teenage pregnancies, 11.8% were already multigravida (Proportion, 0.118; CI, 0.029-0.374). Among teen pregnancies, 18.6% were illiterate; among the literate, only 25.9% were of education above grade 10,31.9% were unaware of contraceptive methods, and only 3.2% reported using any contraception methods. 75.4% of teenage pregnancies had a vaginal delivery with or without episiotomy, 6.5% by instrumental deliveries, and 21.5% by cesarean section. Preterm delivery was 12.0%, and post-term delivery was 8.2%. Abortion was reported in 11.1% of teenage pregnancies. Major tears were reported in 52.9%, obstructed labor was in 4%, and pre-labor rupture of the membrane was in 7.0% of teenage pregnancies. The low birth weight of newborns was 19.4%. Stillbirth and neonatal deaths were 1.7% and 1.4%, respectively. Conclusion The prevalence of teenage pregnancy in Nepal was 13.2%. The majority of them did not use any form of contraceptives; and had low education. Several maternal and neonatal complications were reported among teenage pregnancies.

Background COVID-19 pandemic changed clinical practices more so for otolaryngologists due to inevitable risk of exposure. Objective To assess the changes in the clinical practice among Nepalese otolaryngologists during this pandemic. Method It was an observational study conducted as an online survey in the first two weeks of December 2020. A questionnaire pertaining to changes in clinical practice was mailed to 190 registered otolaryngologists working in various provinces of Nepal. Data were entered in Microsoft Excel 2007 and analysed in percentages. Result Out of the 77 (40.5%) who responded, nearly 50% resumed clinical practice after a month of national lockdown restarting everyday consultation by 64.9% mostly in hospital setting (81.8%) after screening patients via fever clinic by 87%. Modifications in clinical examinations was mostly done for neck (85.7%), oral cavity (44.2%) and nose (29.8%) examination with least with for ear examination (3.9%) Regular endoscopic evaluation was avoided by 19.4%. Only around 57% used adequate personal protective equipment. There was 93.5% reduction in elective operations. Mandatory COVID test was done by 89.6% mostly with reverse transcriptase polymerase chain reaction (95.9%) prior to semi-urgent case. Conclusion Changes in clinical practice were adapted to mitigate viral transmission. The changes were evident in the outpatient department where most patients were screened for fever and modifications made in the clinical examinations. Personal protective equipments were worn when available. Operative lists were limited to semi-urgent and urgent cases with covid testing customarily done for semi-urgent cases.

BACKGROUND:Steroids have been proven to be beneficial in improving post-operative outcomes following sinus surgery. The ideal mode of delivery is to increase local concentration in the sinuses with minimal systemic side effects. In this study, we used triamcinolone soaked polyvinyl alcohol packs immediately following sinus surgery, and assessed the effects on post-operative outcomes.METHODOLOGY:This was a prospective, interventional, and comparative study. Following endoscopic sinus surgery, a polyvinyl alcohol pack was placed in both nasal cavities and 4 ml triamcinolone was infiltrated in one side and 4 ml of normal saline was infiltrated in the other. The pack was removed on the second post-operative day and nasal cavities and paranasal sinuses were evaluated using a flexible endoscope in the third post-operative week using Lund-Kennedy and Peri-operative sinus endoscopic scores.RESULTS:There was a reduction in the average Lund-Kennedy score and Peri-operative sinus endoscopy score in the treatment site compared to the control site which was statistically significant. There was a greater reduction in crusting, oedema and scarring in the treatment site compared to the control site. However, only the reduction in oedema was statistically significant.CONCLUSIONS:Triamcinolone soaked polyvinyl alcohol pack following endoscopic sinus surgery improves post-operative outcomes.

Epidermal growth factor receptor (EGFR) and its downstream phosphatidylinositol 3-kinase (PI3K) pathway are commonly deregulated in many cancers including head and neck cancer (HNC). Recently, we have shown that the IQ motif-containing GTPase-activating protein 1 (IQGAP1) provides a molecular platform to scaffold all the components from the PI3K-Akt pathway and results in the sequential generation of phosphatidylinositol-3,4,5-triphosphate (PI3,4,5P3). This makes the IQGAP1-PI3K scaffold a promising therapeutic target. In addition to the PI3K-Akt pathway, IQGAP1 also scaffolds the Ras-ERK pathway. To identify an IQGAP1 mutant that specifically loses IQGAP1-PI3K signaling but not other functions, we have focused on the IQ3 motif since this region binds with both the PIPK1 and PI3K enzymes and a short peptide derived from this sequence blocks binding and PI3K signaling. An IQ3 deletion mutant ({triangleup}IQ3) in IQGAP1 was functionally compared with wild-type (WT) IQGAP1. We found that the IQ3 domain specifically mediates the PI3K-Akt pathway but does not regulate the Ras-ERK pathway. The IQ3 deletion mutant lost interactions with PI3K-Akt components but retained its binding of ERK pathway components and cell surface receptors, EGFR and integrins. In addition, the IQ3 deletion mutant lost regulation of cell migration. Consistently, the IQ3 motif derived peptide blocked Akt activation and led to the blockage of invasion mediated by EGFR organized into an integrin complex by syndecan-4. Taken together, this work has defined the IQGAP1 IQ3 motif as a specific target sequence for the scaffolding of the PI3K-AKT pathway.

Triple vessel disease, a coronary artery disease caused by narrowing of plagues which is cholesterol deposit on the vessel wall resulting abnormal and gradual ticking-off the lining of the heart arteries condition known as atherosclerosis. The narrowing usually develops slowly over many years. Thishigh-risk case was operated by the team in TUTH ENT Operation theater. We report a 75-year-old man with triple vessel diseasewith diagnosisof right allergic fungal rhinosinusitis with left deviated nasal septumsuccessfully undergone right Functional Endoscopic Sinus Surgery and recovered. It had emergent condition.

Introduction: The objective of this study was to compare the surgical outcome of endoscopic dacyrocystorhinostomy with or without stenting. It was a prospective, randomized study conducted from October 2011 to September 2013. Ganesh Man Singh Memorial Academy for ENT-Head and Neck Studies ,Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal. Methods: Patients aged 15 years and above of all genders with primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Forty patients were randomly allocated into two groups, 20 each in Endoscopic Dacyrocystorhinostomy with stenting (EwS) and Endoscopic Dacyrocystorhinostomy without stenting (EoS). Post-operative assessment was done at 8 weeks. In the subjective assessment using with 5-point Likert Scale of degree of epiphora, a score of 1, 2 or 3 was considered a success. Objective assessment with syringing and endoscopic evaluation of patency of rhinostome considered patent and partly patent lacrimal system on syringing and patent rhinostome as success. Results: Both the subjective and objectivesuccess rate was 95% in EwS and 90% in EoS.However, there was no significant statistical difference between the two groups (p value =1.00). Conclusion: The success rate of EwS was comparable to that of EoS with no added benefit in our study. In addition, EoS avoided the complications associated with stenting. So, we recommend EoS for PANDO.

Introduction: CT scan of abdomen is usually performed in 120-140 kVp and such high ranges of kilovoltage in all phases will increases the radiation dose many fold. The purpose of the study was to qualitatively and quantitatively assess image quality with low kVp in arterial phase of examination of multiphasic abdominal CT study. Methods: A prospective cross-sectional study was done in 206 participants of age 18 to 88 years who were undergoing multiphase CT studies of the abdomen in Neusoft 16 detector MDCT. After performing non contrast scan, arterial phase study of limited region of abdomen (diaphragm to infrarenal margins) was obtained with 90 kVp. The portovenous phase scan with standard protocol was obtained (120kVp). All other scanning parameters were kept same for two phases. Images were rated on 5 point scale (1-worst, 2-Suboptimal, 3-adequate,4-very good,5-excellent) based on visualization of boundaries, anatomical details of the organs and visualization of noise and artifact by two radiologists. Patient weight, abdominal circumference (AC), height and BMI were recorded and correlated with the image quality score. Statistical analysis was done with Wilcoxon’s signed ranks test k test and descriptive analysis. Results: Overall the image quality of portovenous phase was significantly better (p<0.005) than low kVp arterial phase. Image quality score correlated best with abdominal circumference in standard dose technique (r=0.54) and patient weight in reduced dose technique (r=0.44). Arterial phase scanning had acceptable image quality score for patient weight of <60 kg, AC <80cm and BMI<25 kg/m2. The CTDIvol was 7.71 with reduced kVp protocol and 20.02 with standard resulting significant reduction in radiation dose of about 61% Conclusions: The image quality of arterial phase images with 90kVp tube potential is acceptable in thin and average built patients. Hence reduction in radiation dose is possible if arterial phase scanning is done with reduced kVp except in patients with large anthropometric parameters.

BACKGROUND:Gestational Diabetes Mellitus (GDM) is in increasing trend recently. It is associated with adverse effects on both mother and fetus. Thus, diagnosis of GDM is an important public health issue. This study aimed to determine the frequency of gestational diabetes mellitus in three rural districts of Nepal.METHODS:A hospital based study was conducted in three districts representing mountain, hill and Terai belts of Nepal during the period of July 2009 to June 2010. A total of 564 pregnant women were interviewed and tested for blood glucose as per WHO guideline Results: In Nepal, only 2.5% of pregnant women had GDM according to WHO criteria while it was 6.6% according to IADPSG criteria. Overall mean blood glucose among pregnant women was 72.1 (fasting) and 95.8 (after 2 hrs of 75 gm glucose intake) in which it was 62.8, and 75.1 in Dhading, 78.7 and 88.9 in Dhangadhi, and 98.3 and 99.3 in Solukhumbu districts respectively. Pregnant women with increased age were significantly at high risk of having GDM than those of younger women (p=0.04). There were non-significant differences in GDM by District, Ethnic group and family history of DM.CONCLUSIONS:Gestational diabetes in the rural areas of Nepal is variable with two different criterias (2.5% vs 6.56%). Increasing age was an important influencing factor. Special attention should be given on women with increasing age. There was no significant difference in prevalence of GDM in three ecobelts of Nepal despite of altitude and cultural variability.

Epithelial cells acquire migratory/invasive and stemness traits upon conversion to the mesenchymal phenotype. The expression of E-cadherin is a key to this transition; yet precise understanding of the pathways involved in integrating E-cadherin loss to the gain of mesenchymal traits remains poorly understood. Here, we show that phosphoinositide-generating enzyme, PIPKIγ, expression is upregulated upon epithelial–mesenchymal transition (EMT) and together with the cytoskeletal protein talin assemble into a signaling complex upon E-cadherin loss. PIPKIγ and talin together control the adhesion and phosphoinositide signaling that regulates conversion to the mesenchymal phenotypes. PIPKIγ and talin regulate the stability of E-cadherin transcriptional repressors, snail and slug, induced by transforming growth factor-β1 or extracellular matrix protein. Loss of PIPKIγ or talin or their interaction impaired EMT and the acquisition of cell motility and stemness. This demonstrates a mechanism where a phosphoinositide-generating enzyme PIPKIγ couples with a cytoskeletal protein talin to control the acquisition of mesenchymal phenotypes.