U. Laudari, Rosi Pradhan, D. Shrestha, B. Timilsina, S. Sapkota, D. Karki, Suraj Lamichhane, A. Parajuli
INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals.
{"title":"Laparoscopic cholecystectomy during COVID-19 pandemic- Retrospective analysis of tertiary care centre","authors":"U. Laudari, Rosi Pradhan, D. Shrestha, B. Timilsina, S. Sapkota, D. Karki, Suraj Lamichhane, A. Parajuli","doi":"10.3126/nmmj.v2i2.41282","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41282","url":null,"abstract":"INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. \u0000METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. \u0000RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. \u0000CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129759713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World is threatened by different variants of Coronavirus to an extent that life has been jeopardized in all services including eye care facility. Contact lenses which are one of the preferred modes of vision correction are not an exception to COVID-19 infection. Recently there is confusion among practitioners and patients regarding the safety of contact lens use during COVID-19. This review article summarizes the current recommendations and findings regarding contact lens use during COVID-19. Though eye health professionals and contact lens users are at risk to contract Coronavirus, with proper care, maintenance and disinfection techniques, it would be safe to continue wearing contact lenses. There is currently no strong evidence to suggest that contact lenses are not safe to wear during COVID 19 times. Eye care practitioners responsible for contact lens application must wear special surgical masks, protective glasses or visors and disposable waterproof gloves. Regarding soft contact lenses, preferably daily disposable lenses should be used from the sterile packages. Similarly for rigid gas permeable lenses, lenses made up of fluoropolymer contained in sealed packages must be motivated for the individuals. Since the infected hands can bring the virus to the eyes, contact lens users should avoid touching the nose, mouth and eye unnecessarily. Contact lens after each use must be disinfected with hydrogen peroxide solutions with a special catalyst container. In the case of eye redness and Flu like symptoms, contact lens trial and wearing practices should be suspended or postpone till the condition becomes normal. To minimize the contact time between the patient and examiner soft copy of the instruction sheet, teleconsultation should be motivated. Though the eye is an unlikely site for Coronavirus infection, eye doctors should warn the contact lens wearers to follow scrupulous contact lens hygiene rules.
{"title":"Safe Contact Lens Practices during Coronavirus (COVID-19) Pandemic","authors":"S. Bhattarai","doi":"10.3126/nmmj.v2i2.41286","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41286","url":null,"abstract":"World is threatened by different variants of Coronavirus to an extent that life has been jeopardized in all services including eye care facility. Contact lenses which are one of the preferred modes of vision correction are not an exception to COVID-19 infection. Recently there is confusion among practitioners and patients regarding the safety of contact lens use during COVID-19. This review article summarizes the current recommendations and findings regarding contact lens use during COVID-19. Though eye health professionals and contact lens users are at risk to contract Coronavirus, with proper care, maintenance and disinfection techniques, it would be safe to continue wearing contact lenses. There is currently no strong evidence to suggest that contact lenses are not safe to wear during COVID 19 times. Eye care practitioners responsible for contact lens application must wear special surgical masks, protective glasses or visors and disposable waterproof gloves. Regarding soft contact lenses, preferably daily disposable lenses should be used from the sterile packages. Similarly for rigid gas permeable lenses, lenses made up of fluoropolymer contained in sealed packages must be motivated for the individuals. Since the infected hands can bring the virus to the eyes, contact lens users should avoid touching the nose, mouth and eye unnecessarily. Contact lens after each use must be disinfected with hydrogen peroxide solutions with a special catalyst container. In the case of eye redness and Flu like symptoms, contact lens trial and wearing practices should be suspended or postpone till the condition becomes normal. To minimize the contact time between the patient and examiner soft copy of the instruction sheet, teleconsultation should be motivated. Though the eye is an unlikely site for Coronavirus infection, eye doctors should warn the contact lens wearers to follow scrupulous contact lens hygiene rules.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127463754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-14DOI: 10.21203/RS.3.RS-618682/V1
A. Shrestha, S. Bhattarai, S. Shrestha, M. Chand, A. Bhattarai
Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.
{"title":"Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature.","authors":"A. Shrestha, S. Bhattarai, S. Shrestha, M. Chand, A. Bhattarai","doi":"10.21203/RS.3.RS-618682/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-618682/V1","url":null,"abstract":"\u0000 Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129031297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: Vitamin D deficiency has been frequently reported in many causes of chronic liver disease and has been associated with the development and evolution of non-alcoholic fatty liver disease (NAFLD).The study was done to explore associations between serum vitamin D concentrations among obesity, diabetes mellitus, hypothyroidism, and metabolic syndrome and its effects on liver fibrosis by ultra-sonogram and 2 d shear wave elastography in patients with non-alcoholic fatty liver disease (NAFLD). Methods: A hospital based prospective observational study was conducted from May 2019 for twelve months period in Gastroenterology Unit, NAMS, Nepal. Seventy patients with known fatty liver identified by Ultrasonogram criteria were enrolled. All patients were evaluated by different fibrosis scores (NAFLD Fibrosis, FIB4, APRI, AST/ALT ratio) and 2d shear wave score. Patients were evaluated for Vitamin D level and its effects on obesity, diabetes mellitus, thyroid related disease, dyslipidemias and NAFLD. Results: Among 70 patients, 39 (55.7%) were male and 31 (44.3%) were female with mean age of 44.3 years. Most of the patients were overweight with mean BMI of 28.2 kg/m2; among them 51 (72.9%) were more than 25.kg/m2. About 41.4% had diabetes mellitus, 77.1% had hypertension, 30% had hypothyroidism and 25.9% had metabolic syndrome. Majority of patients on ultrasound grading were mild with 64.28%; 25.72% were moderate and only 10 % were in severe groups. A study of 2 d shear wave elastography showed mean fibrosis of 7.07 kpa for mild grade, 8.22 kpa for moderate grade and 18.16 kpa for severe grade. The mean value of vitamin D was 22.61iu/ml for mild grade, 24.89 iu/ml for moderate grade and 17.4 iu/ml for severe grade. Conclusion: The results of this study showed high prevalence of serum 25(OH) vitamin D inadequacy in individuals with obesity, diabetes mellitus, hypothyroidism and metabolic syndrome which worsens as the stage of liver disease progresses.
{"title":"Relationship between Nonalcoholic Fatty Liver Disease and Vitamin D in Nepal","authors":"M. Sah, R. Shrestha, B. Shrestha, D. Khadka","doi":"10.3126/NMMJ.V2I1.37217","DOIUrl":"https://doi.org/10.3126/NMMJ.V2I1.37217","url":null,"abstract":"Background and Aims: Vitamin D deficiency has been frequently reported in many causes of chronic liver disease and has been associated with the development and evolution of non-alcoholic fatty liver disease (NAFLD).The study was done to explore associations between serum vitamin D concentrations among obesity, diabetes mellitus, hypothyroidism, and metabolic syndrome and its effects on liver fibrosis by ultra-sonogram and 2 d shear wave elastography in patients with non-alcoholic fatty liver disease (NAFLD). \u0000Methods: A hospital based prospective observational study was conducted from May 2019 for twelve months period in Gastroenterology Unit, NAMS, Nepal. Seventy patients with known fatty liver identified by Ultrasonogram criteria were enrolled. All patients were evaluated by different fibrosis scores (NAFLD Fibrosis, FIB4, APRI, AST/ALT ratio) and 2d shear wave score. Patients were evaluated for Vitamin D level and its effects on obesity, diabetes mellitus, thyroid related disease, dyslipidemias and NAFLD. \u0000Results: Among 70 patients, 39 (55.7%) were male and 31 (44.3%) were female with mean age of 44.3 years. Most of the patients were overweight with mean BMI of 28.2 kg/m2; among them 51 (72.9%) were more than 25.kg/m2. About 41.4% had diabetes mellitus, 77.1% had hypertension, 30% had hypothyroidism and 25.9% had metabolic syndrome. Majority of patients on ultrasound grading were mild with 64.28%; 25.72% were moderate and only 10 % were in severe groups. A study of 2 d shear wave elastography showed mean fibrosis of 7.07 kpa for mild grade, 8.22 kpa for moderate grade and 18.16 kpa for severe grade. The mean value of vitamin D was 22.61iu/ml for mild grade, 24.89 iu/ml for moderate grade and 17.4 iu/ml for severe grade. \u0000Conclusion: The results of this study showed high prevalence of serum 25(OH) vitamin D inadequacy in individuals with obesity, diabetes mellitus, hypothyroidism and metabolic syndrome which worsens as the stage of liver disease progresses. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122866458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute appendicitis is the most common surgical emergency of the abdomen. Perforated appendicitis often has higher morbidity and mortality. Laparoscopic Appendectomy (LA) is safe and effective procedure for the simple appendicitis compared to Open Appendectomy (OA) but it is not considered as the first line approach in case of perforated appendicitis and its role is still controversial and is under investigation. Hence this study was carried out to compare the outcomes of LA over OA in proven cases of perforated appendicitis. Methods: A hospital based comparative study was conducted among 60 patients with the diagnosis of perforated appendicitis who underwent LA and OA, for a duration of 18 months in Manipal Teaching Hospital, Pokhara. Data were collected using semi-structured questionnaire and were analyzed by descriptive and inferential statistics with SPSS version 25.0. Results: The study showed no significant statistical difference in operative time in LA compared to OA (66±18.11 minutes vs. 66.67±25.269 minutes, p = 0.9). Moreover it shows less post-operative pain (p = 0.003), shorter length of hospital stay (5.3±1.8 days vs. 7.3±3.31 days, p = 0.005), faster return of peristalsis (1.43±0.504 days vs 1.80±0.805 days, p = 0.037) and faster reinstitution of liquid diet(1.43±0.504 days vs 1.80±0.805 days, p = 0.037), less incidence of wound infection (5 in 30 = 16.66% vs. 12 in 30 = 40%, p = 0.042) and faster subjective full recovery(1.9±0.759 weeks vs. 2.9±0.89 weeks, p ˂ 0.0001) of LA patient compared to OA which is statistically significant. Conclusion: LA is safe and effective procedure than OA for perforated appendicitis.
背景:急性阑尾炎是最常见的腹部外科急症。穿孔性阑尾炎通常有较高的发病率和死亡率。腹腔镜阑尾切除术(LA)相对于开放式阑尾切除术(OA)是治疗单纯性阑尾炎安全、有效的方法，但它不被认为是治疗穿孔性阑尾炎的首选方法，其作用仍有争议，尚在研究中。因此，本研究旨在比较经证实的穿孔性阑尾炎病例中LA与OA的结果。方法:以医院为基础，对60例诊断为穿孔性阑尾炎并行LA和OA手术的患者进行为期18个月的比较研究。采用半结构化问卷收集资料，采用SPSS 25.0版本的描述统计和推理统计进行分析。结果:LA与OA的手术时间差异无统计学意义(66±18.11 min vs 66.67±25.269 min, p = 0.9)。术后疼痛更少(p = 0.003)，住院时间更短(5.3±1.8天比7.3±3.31天，p = 0.005)，肠蠕动恢复更快(1.43±0.504天比1.80±0.805天，p = 0.037)，恢复流食更快(1.43±0.504天比1.80±0.805天，p = 0.037)，伤口感染发生率更低(30组5例= 16.66%比30组12例= 40%，p = 0.042)，主观完全恢复更快(1.9±0.759周比2.9±0.89周)。p小于0.0001)，与OA患者相比具有统计学意义。结论:手术治疗穿孔性阑尾炎安全有效。
{"title":"Perforated Appendicitis Treated By Open Versus Laparoscopic Surgery- A Comparative Study","authors":"B. Timilsina, O. Karki, B. Subedi","doi":"10.3126/NMMJ.V2I1.37215","DOIUrl":"https://doi.org/10.3126/NMMJ.V2I1.37215","url":null,"abstract":"Background: Acute appendicitis is the most common surgical emergency of the abdomen. Perforated appendicitis often has higher morbidity and mortality. Laparoscopic Appendectomy (LA) is safe and effective procedure for the simple appendicitis compared to Open Appendectomy (OA) but it is not considered as the first line approach in case of perforated appendicitis and its role is still controversial and is under investigation. Hence this study was carried out to compare the outcomes of LA over OA in proven cases of perforated appendicitis. \u0000Methods: A hospital based comparative study was conducted among 60 patients with the diagnosis of perforated appendicitis who underwent LA and OA, for a duration of 18 months in Manipal Teaching Hospital, Pokhara. Data were collected using semi-structured questionnaire and were analyzed by descriptive and inferential statistics with SPSS version 25.0. \u0000Results: The study showed no significant statistical difference in operative time in LA compared to OA (66±18.11 minutes vs. 66.67±25.269 minutes, p = 0.9). Moreover it shows less post-operative pain (p = 0.003), shorter length of hospital stay (5.3±1.8 days vs. 7.3±3.31 days, p = 0.005), faster return of peristalsis (1.43±0.504 days vs 1.80±0.805 days, p = 0.037) and faster reinstitution of liquid diet(1.43±0.504 days vs 1.80±0.805 days, p = 0.037), less incidence of wound infection (5 in 30 = 16.66% vs. 12 in 30 = 40%, p = 0.042) and faster subjective full recovery(1.9±0.759 weeks vs. 2.9±0.89 weeks, p ˂ 0.0001) of LA patient compared to OA which is statistically significant. \u0000Conclusion: LA is safe and effective procedure than OA for perforated appendicitis. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115937623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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