Pub Date : 2020-12-31DOI: 10.3126/jngmc.v18i1.35189
Dipendra Kc, D. Shrestha, P. Karki, S. Shrestha, Sushil Yogi, S. Giri
Introduction: Galeazzi fracture-dislocation is a complex traumatic disruption of the distal radioulnar joint (DRUJ) that is associated with lower shaft radius fracture. Galeazzi fractures are extremely unstable, and the results of nonsurgical treatment are uniformly unsatisfactory. Galeazzi fractures managed with closed modalities have unsatisfactory clinical results in most of the patients in published literature so open reduction and internal fixation with plating is the standard treatment for this fracture. Aims: The aim of this study was to evaluate the functional outcome of Galeazzi fracture dislocation. Methods: This prospective study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur, from April 2016 to March 2019. It included 35 patients of age group 19 to 49. All of the fractures in this study were treated by open reduction and internal fixation (ORIF) with 3.5 mm narrow dynamic compression plate (DCP) and cortical screws via Henrys anterior approach and distal radioulnar joint (DRUJ) stabilization was done with 1 Kirschner wire (K-wire) inserted parallel to the wrist joint. Patients were observed at 6, 10, 16 and 24 weeks and 52 weeks both radiographically and clinically. Results: In this study of 35 patients, 24 (68.57%) were males and 11 (31.43%) were females with the age range of 19 to 49 years and mean age of 35 and standard deviation (SD) of ±1.5 years. Majority of fractures were observed between 31 to 40 years of age. Most of the injuries were due to fall injury 51.42%. The average duration from time of injury to surgery was 5 days and bone grafting was not needed in any cases. The average time period for union was about 16 weeks. The most common complication seen in this study was stiffness of wrist (11.42%). Twenty four patients (68.57%) had good result, 10 patients (28.57%) had fair result and one patient (2.86%) had poor result in DASH score at final follow-up. Conclusion: Open reduction and internal fixation with plating and stabilization of distal radioulnar joint with K wire yields good to fair outcome on Disabilities of Arm, Shoulder and Hand Score.
{"title":"Functional Outcome of Galezzi Fracture Dislocation in Adults Treated With Dynamic Compression Plate and Kirschner Wire","authors":"Dipendra Kc, D. Shrestha, P. Karki, S. Shrestha, Sushil Yogi, S. Giri","doi":"10.3126/jngmc.v18i1.35189","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35189","url":null,"abstract":"Introduction: Galeazzi fracture-dislocation is a complex traumatic disruption of the distal radioulnar joint (DRUJ) that is associated with lower shaft radius fracture. Galeazzi fractures are extremely unstable, and the results of nonsurgical treatment are uniformly unsatisfactory. Galeazzi fractures managed with closed modalities have unsatisfactory clinical results in most of the patients in published literature so open reduction and internal fixation with plating is the standard treatment for this fracture.\u0000Aims: The aim of this study was to evaluate the functional outcome of Galeazzi fracture dislocation.\u0000Methods: This prospective study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur, from April 2016 to March 2019. It included 35 patients of age group 19 to 49. All of the fractures in this study were treated by open reduction and internal fixation (ORIF) with 3.5 mm narrow dynamic compression plate (DCP) and cortical screws via Henrys anterior approach and distal radioulnar joint (DRUJ) stabilization was done with 1 Kirschner wire (K-wire) inserted parallel to the wrist joint. Patients were observed at 6, 10, 16 and 24 weeks and 52 weeks both radiographically and clinically.\u0000Results: In this study of 35 patients, 24 (68.57%) were males and 11 (31.43%) were females with the age range of 19 to 49 years and mean age of 35 and standard deviation (SD) of ±1.5 years. Majority of fractures were observed between 31 to 40 years of age. Most of the injuries were due to fall injury 51.42%. The average duration from time of injury to surgery was 5 days and bone grafting was not needed in any cases. The average time period for union was about 16 weeks. The most common complication seen in this study was stiffness of wrist (11.42%). Twenty four patients (68.57%) had good result, 10 patients (28.57%) had fair result and one patient (2.86%) had poor result in DASH score at final follow-up.\u0000Conclusion: Open reduction and internal fixation with plating and stabilization of distal radioulnar joint with K wire yields good to fair outcome on Disabilities of Arm, Shoulder and Hand Score.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124121195","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35172
P. Karki, Roshani Ranabhat, A. Shah
Introduction: Displaced radial neck fracture in children when poorly managed results in deformity of elbow and incapacitates patient’s daily activities due to compromised forearm motion, hence they require careful attention. Aims: The aim of this study is to assess the outcome of Métaizeau Technique in displaced radial neck fracture in Children. Methods: This hospital based study evaluated the treatment outcome of 35 patients with an average age of 9.34 years (range, 6 – 14 years), who presented with displaced radial neck fracture; and were treated by Métaizeau technique of intramedullary pinning by Kirschners (K) wire at Nepalgunj Medical College, Kohalpur from April 2017 to January 2020. Only Judet’s type 3 and 4 fractures were included in this study. Close reduction was attempted in all cases. All patients were followed up for an average of 8.4 months (range, 6-12 months). Functional outcome was assessed as per Métaizeau functional score. Results: All fractures united at an average of 3.77 0.84 months (meanSD). Twenty seven patients had type 3 fracture and remaining 8 had type 4a fracture. Twenty five (92.5%) patients with type 3 fracture exhibited excellent results; while three patients (37.5%) with type 4a fracture had excellent outcome. Closed reduction produced excellent outcome in all patients while 80.95% patients with percutaneous reduction had excellent result. Conclusion: Outcome depends on initial fracture type and mode of reduction. Closed reduction should be preferred over an open reduction in order to achieve superior outcome.
{"title":"Treatment Outcome of Métaizeau Technique of Intramedullary Pinning in Pediatric Displaced Radial Neck Fracture","authors":"P. Karki, Roshani Ranabhat, A. Shah","doi":"10.3126/jngmc.v18i1.35172","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35172","url":null,"abstract":"Introduction: Displaced radial neck fracture in children when poorly managed results in deformity of elbow and incapacitates patient’s daily activities due to compromised forearm motion, hence they require careful attention.\u0000Aims: The aim of this study is to assess the outcome of Métaizeau Technique in displaced radial neck fracture in Children.\u0000 Methods: This hospital based study evaluated the treatment outcome of 35 patients with an average age of 9.34 years (range, 6 – 14 years), who presented with displaced radial neck fracture; and were treated by Métaizeau technique of intramedullary pinning by Kirschners (K) wire at Nepalgunj Medical College, Kohalpur from April 2017 to January 2020. Only Judet’s type 3 and 4 fractures were included in this study. Close reduction was attempted in all cases. All patients were followed up for an average of 8.4 months (range, 6-12 months). Functional outcome was assessed as per Métaizeau functional score.\u0000Results: All fractures united at an average of 3.77 0.84 months (meanSD). Twenty seven patients had type 3 fracture and remaining 8 had type 4a fracture. Twenty five (92.5%) patients with type 3 fracture exhibited excellent results; while three patients (37.5%) with type 4a fracture had excellent outcome. Closed reduction produced excellent outcome in all patients while 80.95% patients with percutaneous reduction had excellent result.\u0000Conclusion: Outcome depends on initial fracture type and mode of reduction. Closed reduction should be preferred over an open reduction in order to achieve superior outcome.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126455912","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35174
S. Bhandari, Sulav Shrestha, D. Paudel
Introduction: Chronic otitis media is one of the most common ear diseases in developing countries like Nepal and is important cause of the hearing loss. Chronic otitis media is rarely an isolated entity, because the responsible factors for its development in one ear in similar way will impact the contralateral ear, since both ears have a common “nasopharyngeal” drainage. Contralateral ear is defined as asymptomatic ear in cases of unilateral chronic otitis media. Aims: To evaluate the audiological profile of Contralateral ear in post-operative subjects of unilateral otorrhoea. Methods: Patients fulfilling criteria underwent Otoscopic examination, tuning fork test and pure tone audiometry. The findings of contralateral ear like retraction, tympanosclerotic patch (TS patch), thin, dull and atrophied tympanic membrane were noted. The final diagnosis with the type of surgery of diseased ear, as well as status of contralateral ear were entered into the proforma. All the patients were followed till three months in relation to anatomy of Tympanic membrane onotomicroscopy and pure tone audiometry respectively. Results: In postoperative cases of mucosal disease, the cases with abnormality in the contralateral ear reduced from 17 to 10 patients (30.3%) and the normal patients increased from 16 to 23 cases (69.7%). Likewise, in postoperative squamous disease, the cases with abnormality in the contralateral ear reduced from 14 to 11 patients (64.7%) and the normal patients increased from 3 to 6 cases (35.3%). Out of 50 cases, 14 cases (28%) had defective hearing while 36 cases (72%) had normal hearing in the contralateral ear respectively. Conclusion: The high incidence of occurrence of abnormality in contralateral ear indicate that both ears should be regarded as a pair. Unilateral Chronic otitis media should not be taken as a static phenomenon but as a continuous process in the other ear too.
{"title":"Assessment of the Status of Contralateral Ear in Post-Operative Subjects of Unilateral Chronic Otorrhoea","authors":"S. Bhandari, Sulav Shrestha, D. Paudel","doi":"10.3126/jngmc.v18i1.35174","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35174","url":null,"abstract":"Introduction: Chronic otitis media is one of the most common ear diseases in developing countries like Nepal and is important cause of the hearing loss. Chronic otitis media is rarely an isolated entity, because the responsible factors for its development in one ear in similar way will impact the contralateral ear, since both ears have a common “nasopharyngeal” drainage. Contralateral ear is defined as asymptomatic ear in cases of unilateral chronic otitis media.\u0000Aims: To evaluate the audiological profile of Contralateral ear in post-operative subjects of unilateral otorrhoea.\u0000Methods: Patients fulfilling criteria underwent Otoscopic examination, tuning fork test and pure tone audiometry. The findings of contralateral ear like retraction, tympanosclerotic patch (TS patch), thin, dull and atrophied tympanic membrane were noted. The final diagnosis with the type of surgery of diseased ear, as well as status of contralateral ear were entered into the proforma. All the patients were followed till three months in relation to anatomy of Tympanic membrane onotomicroscopy and pure tone audiometry respectively.\u0000Results: In postoperative cases of mucosal disease, the cases with abnormality in the contralateral ear reduced from 17 to 10 patients (30.3%) and the normal patients increased from 16 to 23 cases (69.7%). Likewise, in postoperative squamous disease, the cases with abnormality in the contralateral ear reduced from 14 to 11 patients (64.7%) and the normal patients increased from 3 to 6 cases (35.3%). Out of 50 cases, 14 cases (28%) had defective hearing while 36 cases (72%) had normal hearing in the contralateral ear respectively.\u0000Conclusion: The high incidence of occurrence of abnormality in contralateral ear indicate that both ears should be regarded as a pair. Unilateral Chronic otitis media should not be taken as a static phenomenon but as a continuous process in the other ear too.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123514026","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35211
D. Shrestha, M. Shrestha, Dipendra Kc, P. Karki, S. Shrestha, Sushil Yogi
Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.
{"title":"Effectiveness of Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocation Using Clavicle Hook Plate and Tension Band Wiring: A Comparative Study to Evaluate the Functional and Surgical Outcome","authors":"D. Shrestha, M. Shrestha, Dipendra Kc, P. Karki, S. Shrestha, Sushil Yogi","doi":"10.3126/jngmc.v18i1.35211","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35211","url":null,"abstract":"Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews.\u0000Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires.\u0000Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. \u0000Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. \u0000Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121402649","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35185
N. Regmi, Kamar Jahan, Purnima Rai, A. Bhandari
Introduction: Effective post-operative analgesia is mandatory following cesarean section (CS), as parturients need to recover quickly to breast feed and provide care for their newborns. Till date no single drug has been able to achieve this goal. Multimodal analgesia with opioids and non-steroidal anti-inflammatory drugs (NSAID) combination has shown promising results. Aims: To compare the analgesic efficacy, patient satisfaction and maternal adverse effects, between intravenous (IV) tramadol and multimodal analgesia with IV tramadol and IV ketorolac combination for post cesarean section analgesia. Methods: This is a prospective, randomized and single-blinded comparative study, conducted in 60 parturients who underwent Lower Segment Cesarian Section. They were divided into two groups: Group 1 (IV Tramadol 50 mg given 8 hourly) and Group 2 (IV Tramadol 50 mg + IV Ketorolac 30 mg given 8 hourly). IV Promethazine was given with each dose of tramadol in both groups. Results: The (Visual analogue scale) VAS scores were significantly low in IV tramadol + IV ketrolac group than with IV tramadol alone group at 2 hours and 12 hours with p value of 0.003 and 0.08 respectively. Rescue analgesia was significantly reduced in group 2 (p value 0.005). Patient satisfaction was good in group 2 and fair in group 1(p value 0.002). No maternal side effects were found. Conclusion: IV tramadol and IV ketorolac combination used for post cesarean section analgesia significantly decreases post-operative pain, need of rescue analgesia and significantly increases patient satisfaction in comparison to IV tramadol alone.
{"title":"Comparison of Tramadol with Combination of Tramadol and Ketorolac for Post Cesarean Section Analgesia","authors":"N. Regmi, Kamar Jahan, Purnima Rai, A. Bhandari","doi":"10.3126/jngmc.v18i1.35185","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35185","url":null,"abstract":"Introduction: Effective post-operative analgesia is mandatory following cesarean section (CS), as parturients need to recover quickly to breast feed and provide care for their newborns. Till date no single drug has been able to achieve this goal. Multimodal analgesia with opioids and non-steroidal anti-inflammatory drugs (NSAID) combination has shown promising results. \u0000Aims: To compare the analgesic efficacy, patient satisfaction and maternal adverse effects, between intravenous (IV) tramadol and multimodal analgesia with IV tramadol and IV ketorolac combination for post cesarean section analgesia.\u0000Methods: This is a prospective, randomized and single-blinded comparative study, conducted in 60 parturients who underwent Lower Segment Cesarian Section. They were divided into two groups: Group 1 (IV Tramadol 50 mg given 8 hourly) and Group 2 (IV Tramadol 50 mg + IV Ketorolac 30 mg given 8 hourly). IV Promethazine was given with each dose of tramadol in both groups.\u0000Results: The (Visual analogue scale) VAS scores were significantly low in IV tramadol + IV ketrolac group than with IV tramadol alone group at 2 hours and 12 hours with p value of 0.003 and 0.08 respectively. Rescue analgesia was significantly reduced in group 2 (p value 0.005). Patient satisfaction was good in group 2 and fair in group 1(p value 0.002). No maternal side effects were found.\u0000Conclusion: IV tramadol and IV ketorolac combination used for post cesarean section analgesia significantly decreases post-operative pain, need of rescue analgesia and significantly increases patient satisfaction in comparison to IV tramadol alone.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132807786","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35154
K. Sinha, S. Pandey, D. Khadka
Introduction: The incidence of caesarean section is increasing day by day. One of the most common complications is primary or secondary postpartum haemorrhage. Tranexamic acid has been shown to be very useful in reducing blood loss and incidence of blood transfusion in varieties of surgery. Aims: To study the efficacy of tranexamic acid in reducing blood loss during and after the lower segment caesarean section. Methods: Arandomized, case controlled, prospective study was conducted on 100 women undergoing lower segment caesarean section carried out in the Department of Obstetrics and Gynaecology, Nepalgunj Medical College, Kohalpur from Sept 2019 to Feb 2020.Fifty of them were given tranexamic acid immediately before lower segment caesarean section and were compared with 50 others to whom tranexamic acid was not given. Blood loss was collected and measured during two different time interval. The first period was considered from placental delivery to end of lower segment caesarean section and second from the end of lower segment caesarean section to 2 hours postpartum period. Vital signs at time of delivery, at 1 hour and 2 hour postpartum and APGAR score at 1 min and 5 min were studied in both the groups. Results: Tranexamic acid significantly reduced the quantity of blood loss from the placental delivery to 2 hours post-partum: 360.9 ml in the study group, versus 443 ml in the control group (p=0.0008).It also significantly reduced the quantity of blood loss from the end of lower segment caesarean section to 2 hours postpartum:71.5 ml in the study group versus 112.6 ml in the control group (p=0.0002).There was 18% less incidence of postpartum haemorrhage , who received tranexamic acid(p=0.02).There were no significant adverse drug reaction and difference in APGAR score in both the groups. No complications or side effects were reported in either group. Conclusion: Tranexamic acid is safe and effective in reducing blood loss among women undergoing lower segment caesarean section.
导读:剖宫产的发生率日益增加。最常见的并发症之一是原发性或继发性产后出血。氨甲环酸已被证明是非常有用的，在减少失血和输血的发生率在各种手术。目的:探讨氨甲环酸对减少下段剖宫产术中及术后出血量的作用。方法:对2019年9月至2020年2月在尼泊尔科哈尔布尔尼泊尔医学院妇产科行下段剖宫产术的100例妇女进行随机、病例对照、前瞻性研究。下段剖宫产术前立即给予氨甲环酸50例，未给予氨甲环酸50例。在两个不同的时间间隔内收集和测量出血量。第一阶段从胎盘娩出至下段剖宫产结束，第二阶段从下段剖宫产结束至产后2小时。观察两组患儿分娩时、产后1 h、2 h生命体征及1 min、5 min APGAR评分。结果:氨甲环酸显著减少胎盘分娩至产后2小时的失血量:研究组为360.9 ml，对照组为443 ml (p=0.0008)。它还显著减少了下段剖宫产结束至产后2小时的出血量:研究组为71.5 ml，对照组为112.6 ml (p=0.0002)。服用氨甲环酸组产后出血发生率降低18% (p=0.02)。两组患者无明显药物不良反应，APGAR评分差异无统计学意义。两组均无并发症或副作用。结论:氨甲环酸对下段剖宫产术妇女减少出血量安全有效。
{"title":"Efficacy of Tranexamic Acid in Reducing Blood Loss during and After Caesarean Section: A Case control Study","authors":"K. Sinha, S. Pandey, D. Khadka","doi":"10.3126/jngmc.v18i1.35154","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35154","url":null,"abstract":"Introduction: The incidence of caesarean section is increasing day by day. One of the most common complications is primary or secondary postpartum haemorrhage. Tranexamic acid has been shown to be very useful in reducing blood loss and incidence of blood transfusion in varieties of surgery.\u0000Aims: To study the efficacy of tranexamic acid in reducing blood loss during and after the lower segment caesarean section.\u0000Methods: Arandomized, case controlled, prospective study was conducted on 100 women undergoing lower segment caesarean section carried out in the Department of Obstetrics and Gynaecology, Nepalgunj Medical College, Kohalpur from Sept 2019 to Feb 2020.Fifty of them were given tranexamic acid immediately before lower segment caesarean section and were compared with 50 others to whom tranexamic acid was not given. Blood loss was collected and measured during two different time interval. The first period was considered from placental delivery to end of lower segment caesarean section and second from the end of lower segment caesarean section to 2 hours postpartum period. Vital signs at time of delivery, at 1 hour and 2 hour postpartum and APGAR score at 1 min and 5 min were studied in both the groups.\u0000Results: Tranexamic acid significantly reduced the quantity of blood loss from the placental delivery to 2 hours post-partum: 360.9 ml in the study group, versus 443 ml in the control group (p=0.0008).It also significantly reduced the quantity of blood loss from the end of lower segment caesarean section to 2 hours postpartum:71.5 ml in the study group versus 112.6 ml in the control group (p=0.0002).There was 18% less incidence of postpartum haemorrhage , who received tranexamic acid(p=0.02).There were no significant adverse drug reaction and difference in APGAR score in both the groups. No complications or side effects were reported in either group.\u0000Conclusion: Tranexamic acid is safe and effective in reducing blood loss among women undergoing lower segment caesarean section.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124889038","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.34716
M. Marhatta
Not available.
不可用。
{"title":"Medical Education during COVID-19 Crisis: Challenges and Opportunities","authors":"M. Marhatta","doi":"10.3126/jngmc.v18i1.34716","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.34716","url":null,"abstract":"Not available.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125288332","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35131
N. Sharma, Sheela Kumari, B. Durga, M. Shrestha
Introduction: Hypertensive disorders of pregnancy is one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.1 It is the leading cause of direct maternal death along with hemorrhage and infections. Approximately 70% of hypertensive disorders are due to gestational hypertension, preeclampsia and eclampsia whereas other 30% are due to preexisting or undiagnosed hypertension.2 Out of all the hematological abnormalities that occur in PIH, thrombocytopenia is the most common seen to occur in 11% to 29% of patients.3 Thrombocytopenia occurs more commonly in patients with eclampsia (30%) compared to patients with both mild and severe forms of pre-eclampsia (15%-18%).4 Aims :To find out the severity of disease with platelet count in pregnancy induced hypertension. Methods: This is a hospital- based descriptive cross sectional study, conducted in the department of Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal, conducted over a period of one year from September 2018 to August 2019. Fifty pregnant women were enrolled in study after getting informed written consent and assessing for inclusion and exclusion criteria. Results: Incidence of Pre-eclampsia/eclampsia is 2.3% in this study. Majority of the women belong to age group 21-25(40%), followed by 15-20(38%) with mean age 23.18±5.45. 62% constituted primigravidas and 38% were multigravidas. 33 (66%) cases were at term (37-42 weeks of gestation), 11(22%) at 34-36 weeks of gestation and 6 (12%) were at 28-33 weeks of gestation with mean gestational age 36.38±3.17. Eclampsia cases were found more i.e. 48%, followed by pre-eclampsia 38% and Gestational hypertension 14%. Moderately low platelet count was seen in 11.76% of Gestational hypertension, 47% of pre-eclampsia and 41.17% of eclampsia and severely low platelet count in 21.4% pre-eclampsia and 64.70% of eclampsia. Conclusion: PIH continues to be a leading cause of Maternal and perinatal morbidity and Mortality. The disease accounts of 40,000 maternal deaths worldwide per year5. It is one of the common causes of iatrogenic preterm delivery. Etiology of Pre-eclampsia/Eclampsia is complex and not completely understood. A combination of abnormal Placentation and predisposing maternal factor contribute to widespread endothelial dysfunctions which lead to the syndrome of PIH. To date there has been no screening test that has been widely adopted in clinical practice. Platelet estimation method is reliable, rapid, cheaper, and simple lab method. Prognosis of diseases could be monitored by measuring platelet count and level of platelet count can predict the severity of PIH. Therefore assessment of platelet count has special place in management of PIH.
{"title":"Platelet Count and Its Prognostic Value in Pregnancy Induced Hypertension","authors":"N. Sharma, Sheela Kumari, B. Durga, M. Shrestha","doi":"10.3126/jngmc.v18i1.35131","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35131","url":null,"abstract":"Introduction: Hypertensive disorders of pregnancy is one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.1 It is the leading cause of direct maternal death along with hemorrhage and infections. Approximately 70% of hypertensive disorders are due to gestational hypertension, preeclampsia and eclampsia whereas other 30% are due to preexisting or undiagnosed hypertension.2 Out of all the hematological abnormalities that occur in PIH, thrombocytopenia is the most common seen to occur in 11% to 29% of patients.3 Thrombocytopenia occurs more commonly in patients with eclampsia (30%) compared to patients with both mild and severe forms of pre-eclampsia (15%-18%).4 \u0000Aims :To find out the severity of disease with platelet count in pregnancy induced hypertension. \u0000Methods: This is a hospital- based descriptive cross sectional study, conducted in the department of Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal, conducted over a period of one year from September 2018 to August 2019. Fifty pregnant women were enrolled in study after getting informed written consent and assessing for inclusion and exclusion criteria. \u0000Results: Incidence of Pre-eclampsia/eclampsia is 2.3% in this study. Majority of the women belong to age group 21-25(40%), followed by 15-20(38%) with mean age 23.18±5.45. 62% constituted primigravidas and 38% were multigravidas. 33 (66%) cases were at term (37-42 weeks of gestation), 11(22%) at 34-36 weeks of gestation and 6 (12%) were at 28-33 weeks of gestation with mean gestational age 36.38±3.17. Eclampsia cases were found more i.e. 48%, followed by pre-eclampsia 38% and Gestational hypertension 14%. Moderately low platelet count was seen in 11.76% of Gestational hypertension, 47% of pre-eclampsia and 41.17% of eclampsia and severely low platelet count in 21.4% pre-eclampsia and 64.70% of eclampsia. \u0000Conclusion: PIH continues to be a leading cause of Maternal and perinatal morbidity and Mortality. The disease accounts of 40,000 maternal deaths worldwide per year5. It is one of the common causes of iatrogenic preterm delivery. Etiology of Pre-eclampsia/Eclampsia is complex and not completely understood. A combination of abnormal Placentation and predisposing maternal factor contribute to widespread endothelial dysfunctions which lead to the syndrome of PIH. To date there has been no screening test that has been widely adopted in clinical practice. Platelet estimation method is reliable, rapid, cheaper, and simple lab method. Prognosis of diseases could be monitored by measuring platelet count and level of platelet count can predict the severity of PIH. Therefore assessment of platelet count has special place in management of PIH.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125995275","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 : 2019-12-31DOI: 10.3126/jngmc.v17i2.28752
K. Sinha, S. Pandey
Background: Among various community health indicators available for measurement of quality and impact of health services in developing countries, perinatal mortality accounts one of the top most single indicators even today. Documentation and evaluation of the etiology and the associated risk factors for stillbirth is required in order to decrease the fetal mortality rate and to devise plan in maternal health sector. Objective: To find out common risk factors in patient and its association with intrauterine fetal death. Methods: A hospital based cross-sectional study carried out in the Department of OBSGYN, Nepalgunj Medical College, Kohalpur from Jan 2018 to September 2019.Cases of multiple pregnancies, intrapartum death and fetal death diagnosed before 28th weeks of gestation were excluded. After exclusion, 65 cases of intrauterine fetal death were studied. Results: Majority (78.4%) of the patients with IUFD belonged to the reproductive age group(20-35yrs) and (15.4%) belong to <19yrs (p=0.008) associated with illiteracy (84.6%). More than half (58.5%) had at least one ANC visit and were primigravida (17%) with preterm (63.07%). Hypertensive disorder was the commonest obstetric complication in these mothers (36.92%) followed by unexplained (26.15%), anaemia (18.46%), PROM (15.4%), APH (13.8%). Most of the babies were low birth weight (63.69%) and majority were males (63.1%). Conclusion: Majority of the risk factors found in the present study were preventable. Stillbirth rate can be reduced by proper management of these risk factors during antenatal care and intrapartum care.
{"title":"Risk Factors in Patients with Intrauterine Fetal Death at Tertiary Referral Centre","authors":"K. Sinha, S. Pandey","doi":"10.3126/jngmc.v17i2.28752","DOIUrl":"https://doi.org/10.3126/jngmc.v17i2.28752","url":null,"abstract":"Background: Among various community health indicators available for measurement of quality and impact of health services in developing countries, perinatal mortality accounts one of the top most single indicators even today. Documentation and evaluation of the etiology and the associated risk factors for stillbirth is required in order to decrease the fetal mortality rate and to devise plan in maternal health sector. \u0000Objective: To find out common risk factors in patient and its association with intrauterine fetal death. \u0000Methods: A hospital based cross-sectional study carried out in the Department of OBSGYN, Nepalgunj Medical College, Kohalpur from Jan 2018 to September 2019.Cases of multiple pregnancies, intrapartum death and fetal death diagnosed before 28th weeks of gestation were excluded. After exclusion, 65 cases of intrauterine fetal death were studied. \u0000Results: Majority (78.4%) of the patients with IUFD belonged to the reproductive age group(20-35yrs) and (15.4%) belong to <19yrs (p=0.008) associated with illiteracy (84.6%). More than half (58.5%) had at least one ANC visit and were primigravida (17%) with preterm (63.07%). Hypertensive disorder was the commonest obstetric complication in these mothers (36.92%) followed by unexplained (26.15%), anaemia (18.46%), PROM (15.4%), APH (13.8%). Most of the babies were low birth weight (63.69%) and majority were males (63.1%). \u0000Conclusion: Majority of the risk factors found in the present study were preventable. Stillbirth rate can be reduced by proper management of these risk factors during antenatal care and intrapartum care.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129610019","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 : 2019-12-31DOI: 10.3126/jngmc.v17i2.31662
A. Sharma, P. Thapa
Introduction: Gastric cancer (GC) is the second most common cause of cancer-related deaths causing about 800,000 deaths worldwide/year. In Nepal gastric cancer is the second common cancer among males after the lung cancer. Gastric cancer shows a wide variation in incidence worldwide, being highest in Korea and Japan. It is detected early due to the low threshold for upper gastrointestinal endoscopy and screening programs. In the rest of the world and particularly in developing countries, GC is advanced in most of the cases. Inspite of controversies in extent of resection and lymphadenectomy, surgery remains the gold standard treatment. The study was conducted to determine the outcome of the patients with gastric cancer. Methods: The study was conducted in the department of surgery at Nepalgunj Medical College and Teaching Hospital Kohalpur from November 2015 to Dec 2018. Patients diagnosed with GC were studied. The patients with resectable disease underwent radical resection followed by adjuvant chemo-radiation as indicated. Patient’s demography, clinical presentation, stage of disease, types of surgery performed and survival were analysed. Results: 58 patients were diagnosed with gastric cancer. The age ranged from 20-83 years with the mean of 61.26±11.28. Male to female ratio was 2.41: 1. The common clinical presentations were weight loss, anorexia and anemia, 17 (29.31%) had gastric outlet obstruction at initial presentation and 4 (6.89%) presented with perforation peritonitis. Antropyloric region was the commonest site of tumor location seen in 41 (70.68%). 7 (12.06%) patients had distant metastasis and 5 (8.62%) had ascites at presentation. Out of 58 patients, 43 (74.13%) were operated. Only 18 (41.86%) patients underwent R0 resection. 14 (24.13%) underwent palliative gastrojejunostomy. Two (3.44%) patients underwent primary repair for perforation and in 9 (15.51%) the procedure was abandoned due to and presence of metastasis. There was one post-operative mortality. The histology of gastric cancer was found to be adenocarcinoma in all patients. There was no patient in stage I. 3(16.66%) patients were in stage II and 15 (83.33%) in stage III. 17 (29.31%) had stage IV disease. Out of 43 operated patients, 13 lost follow up. All 17 resected patients and those with metastatic disease were followed up. There was no death and no local recurrence in stage II. In stage III, 78.57% were alive and in stage IV 35.29% were alive. Conclusion: Gastric cancer is one of the common gastrointestinal malignancies affecting predominantly male gender. Stage of the disease is one of the major prognostic factors related with the survival. Adenocarcinoma is the commonest histology. Radical resection followed by adjuvant chemotherapy is the standard of care. Palliative chemotherapy can prolong the overall survival in patients with metastatic disease.
{"title":"Surgical Management of Gastric Cancer: An Institutional Experience","authors":"A. Sharma, P. Thapa","doi":"10.3126/jngmc.v17i2.31662","DOIUrl":"https://doi.org/10.3126/jngmc.v17i2.31662","url":null,"abstract":"Introduction: Gastric cancer (GC) is the second most common cause of cancer-related deaths causing about 800,000 deaths worldwide/year. In Nepal gastric cancer is the second common cancer among males after the lung cancer. Gastric cancer shows a wide variation in incidence worldwide, being highest in Korea and Japan. It is detected early due to the low threshold for upper gastrointestinal endoscopy and screening programs. In the rest of the world and particularly in developing countries, GC is advanced in most of the cases. Inspite of controversies in extent of resection and lymphadenectomy, surgery remains the gold standard treatment. The study was conducted to determine the outcome of the patients with gastric cancer. \u0000Methods: The study was conducted in the department of surgery at Nepalgunj Medical College and Teaching Hospital Kohalpur from November 2015 to Dec 2018. Patients diagnosed with GC were studied. The patients with resectable disease underwent radical resection followed by adjuvant chemo-radiation as indicated. Patient’s demography, clinical presentation, stage of disease, types of surgery performed and survival were analysed. \u0000Results: 58 patients were diagnosed with gastric cancer. The age ranged from 20-83 years with the mean of 61.26±11.28. Male to female ratio was 2.41: 1. The common clinical presentations were weight loss, anorexia and anemia, 17 (29.31%) had gastric outlet obstruction at initial presentation and 4 (6.89%) presented with perforation peritonitis. Antropyloric region was the commonest site of tumor location seen in 41 (70.68%). 7 (12.06%) patients had distant metastasis and 5 (8.62%) had ascites at presentation. Out of 58 patients, 43 (74.13%) were operated. Only 18 (41.86%) patients underwent R0 resection. 14 (24.13%) underwent palliative gastrojejunostomy. Two (3.44%) patients underwent primary repair for perforation and in 9 (15.51%) the procedure was abandoned due to and presence of metastasis. There was one post-operative mortality. The histology of gastric cancer was found to be adenocarcinoma in all patients. There was no patient in stage I. 3(16.66%) patients were in stage II and 15 (83.33%) in stage III. 17 (29.31%) had stage IV disease. Out of 43 operated patients, 13 lost follow up. All 17 resected patients and those with metastatic disease were followed up. There was no death and no local recurrence in stage II. In stage III, 78.57% were alive and in stage IV 35.29% were alive. \u0000Conclusion: Gastric cancer is one of the common gastrointestinal malignancies affecting predominantly male gender. Stage of the disease is one of the major prognostic factors related with the survival. Adenocarcinoma is the commonest histology. Radical resection followed by adjuvant chemotherapy is the standard of care. Palliative chemotherapy can prolong the overall survival in patients with metastatic disease.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115072112","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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