Journal of Nepal Health Research Council最新文献

Background: Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region.

Methods: This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done .

Results: Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center.

Conclusions: Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.

Background: The diagnosis of parotid swelling is challenging and investigations like imaging and needle aspiration cytology are helpful. The objective of this study was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) as compared to the histopathology in parotid gland swelling.

Methods: It was a descriptive cross sectional study carried out in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu by reviewing the medical record charts of the patients who had undergone surgery for parotid lesions during the study period of seven and half years. All patients whose fine needle aspiration cytology and histopathology reports were available were included in the study. The data were presented as mean, standard deviation, ratio and percentages. Microsoft excel was used for data analysis.

Results: There were 75 patients included in the study. The age ranged from nine years to 78 years and the mean age being 38.3 17.42 years. The male to female ratio was 1:1.78. The concordance rate between fine needle aspiration cytology and histopathology was 82.7%. The sensitivity and specificity of the fine needle aspiration cytology were 80% and 95% respectively. Similarly, the positive predictive and negative predictive values were 84% and 93% respectively. The diagnostic accuracy of the fine needle aspiration cytology was 91% for the parotid swelling in our study.

Conclusions: The diagnostic accuracy of fine needle aspiration cytology for parotid swellings in our study was excellent. The result of fine needle aspiration cytology is helpful in deciding management plan for parotid lesions.

Background: Military recruits and athletes have high occurrence of stress fractures, with very high incidence among military recruits. Symptomatic stress fractures can be disabling in some people. This study aims at identifying pattern and distribution of such fractures in Nepal Police trainee and assess the risk factors and demographics that may help to develop the local guidelines.

Methods: This study analysed 65 police trainees who presented to the orthopaedic Out Patient Department at Nepal Police and Province Police Hospital diagnosed as a case of stress fracture from 29 December, 2020 to 29 December, 2021. Ethical approval was obtained and different variables analysed were age, sex, Body Mass Index, location of fracture, duration of pain, method of treatment, time to heal the fracture and time to pain free mobilisation of patient.

Results: There were 65 trainees with 86 sites of fracture at different bones with 50.8% (33) of male population. The majority of fracture was located at tibia (58.1%) followed by pubic rami (33.7%) with potentially debilitating fracture neck of femur seen in 4.6% subjects. Mean duration of pain was 20.7±14.2 days with mean time for pain free mobilisation 42.2±17.7 days after presentation. 96.5% of those recovered with conservative treatment (activity restriction or cast).

Conclusions: The location of stress fracture depends upon the type of training or activities. Modification of activities in early phase of training with early visit for medical care in case of trainees with increasing pain may decrease morbidities and complications requiring operative treatment.

Background: To evaluate the Retinal Nerve Fiber Layer and Ganglion Cell Complex thickness using Spectral Domain Optical Coherence Tomography with and without positive family history of Primary Open Angle Glaucoma and its relation to visual field.

Methods: Total 120 eyes with each subjects with positive family history of Primary Open Angle Glaucoma (Group I, n=30) and healthy subjects without positive family history of Primary Open Angle Glaucoma (Group II, n=30) undergone complete ophthalmic evaluation with Retinal Nerve Fiber Layer, Ganglion Cell Complex and VF obtained from Spectral Domain Optical Coherence Tomography RTVue-100 and Humphrey visual field respectively .The measurements were analyzed and compared among two groups using independent-t test by using SPSS version 23.The relationship of Retinal Nerve Fiber Layer with visual field were evaluated with correlation analysis.

Results: There were 75 patients included in the study.nasal, temporal RNFL and average Ganglion Cell Complex was significantly lower and thinner in Group I with mean difference of -8.53±2.30 µm (p<0.001), -7.35±3.34 µm (p<0.001), -8.52±3.58µm (p<0.001),-11.87±2.24µm (p<0.001), -5.31±1.95µm (p<0.001) and -8.05±1.52µm (p<0.001) respectively. Correlation plot with Retinal Nerve Fiber Layer thickness as predictor of Mean Deviation and Pattern Standard Deviation indicated statistically significant degree of determination in Group I (r=0.455 and r=0.623, p<0.001 and p<0.001).

Conclusions: The Optical Coherence Tomography and visual field Parameters are lower in group I and used as an early predictor, diagnosis, monitoring and management.

Background: The American Society of Anaesthesiologists Physical Status classification is deployed by the anaesthesiologists worldwide to classify operative surgical patients. Many studies have found moderate degree of interrater variability among anaesthesiologists. The general objective of the study was to find out interrater variability among Nepalese anesthesiologists using this classification system in Nepal. The specific objectives of the study were to find out the correctness of assignment and inter-rater variability among anaesthesiologists based on their experience.

Methods: Ten clinical cases were distributed among 130 registered anaesthesiologist practitioners of Nepal after validation with the experts. Respondents were asked to assign each of ten cases to a specific physical status class. Anaesthesiologists were classified to two classes based on clinical experience as having more or less than five years of experience.

Results: We found substantial agreement among < 5 year's (0.66) and > 5 year's experience group (0.753) and among all raters (0.736). The mean score of the group with less than 5 years of experience was more. There was no significant difference between the mean score (p = 0.595). Overall mean score for the both groups was 5.66 with SD 1.66. There was no significant difference between the groups.

Conclusions: The study shows that there is very less variation among registered practising anaesthesiologists of Nepal using American Society of Anesthesiologists Physical Status classification system.

Background: Tibial spine avulsion of the anterior cruciate ligament is a rare intraarticular injury of the knee. In this condition, the tibial attachment site of the anterior cruciate ligament is detached from the knee. The mechanism of the injury is hyperextension of the knee and rotation with valgus force. There are so many treatment options. This study aims to find out the functional outcome of Arthroscopic Suture pull-out fixation in this injury.

Methods: This is a retrospective study done from August 15, 2019, to August 14, 2022. The outcome was analyzed by comparing the preoperative and 12-month postoperative International Knee Documentation Committee Score, Tegner Lysholm Score, Knee Range of motion, and Visual Analog Scale Score.

Results: Twenty-two patients were included with a mean age of 18.95 (13-31). Among them 15(68.2%) were male and 7(31.8%) were female. Arthroscopic suture pull-out fixation was done in all the cases. The knee range of motion was improved from preoperatively 35.00±7.86 to 135.68±3.50 at the final follow-up. The Tegner Lysholm score was improved from preoperatively 34.68±1.28 to 94.54±2.97 at the final follow-up. Preoperatively the VAS score was 8.04±1.27 which improved to 0.60±0.50 at the final follow-up. The IKDC score was 23.86±1.42 preoperatively which improved to 92.72±3.28 at the final follow-up with p-value < 0.001 Conclusions: Arthroscopic Suture pull-out fixation of tibial spine avulsion of the Anterior cruciate ligament is a good technique that restores the functions of the knee and has an excellent outcome Keywords: Anterior cruciate ligament; suture pull-out fixation; tibial spine avulsion.

Background: Staphylococcus aureus (S.aureus) is an emerging antibiotic resistant bacterium responsible for various infections in human. Resistance to methicillin and vancomycin are of prime concern in S. aureus. The study aims to determine the minimum inhibitory concentration (MIC) of Vancomycin and evaluate the existence of mecA and vanA genes, associated with antibiotic resistance.

Methods: Clinical specimens from three Kathmandu hospitals were processed and S. aureus was identified using conventional microbiological procedures. MRSA was phenotypically identified with cefoxitin (30µg) disc diffusion, while vancomycin susceptibility was assessed using the Ezy MICTM stripes. The mecA and vanA genes were detected by polymerase chain reaction (PCR).

Results: Out of 266 S. aureus samples from various clinical specimen subjected for analysis, 77 (28.9%) were found methicillin-resistant (MRSA) and 10 (3.8%) were observed vancomycin-resistant (VRSA). Vancomycin resistant isolates showed a significant correlation between resistance to ampicillin, chloramphenicol, and cefoxitin. The mecA gene was found in 39 of the MRSA isolates, having 50.64% of MRSA cases, while the vanA gene was detected in 4 of the VRSA cases, constituting 40% of VRSA occurrences.

Conclusions: The strains with higher vancomycin minimum inhibitory concentration values (≥ 1.5 μg/ml) displayed increased resistance rates to various antibiotics compared to strains with lower minimum inhibitory concentration values (< 1.5 μg/ml). The presence of vanA genes was strongly associated (100%) with vancomycin resistance, while the 10.3% mecA gene was identified from MRSA having resistance towards vancomycin also.

Background: Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury.

Methods: Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population.

Results: Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice.

Conclusions: The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality.

Background: The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital.

Methods: A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0.

Results: There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were "very satisfied", 62.5%(95) patients were "satisfied", 2.6%(4) were "neither satisfied nor dissatisfied" and 2%(3) were "dissatisfied" with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64).

Conclusions: The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences.

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