Pub Date : 2022-12-31DOI: 10.3126/jngmc.v20i2.51835
S. Bhattarai, Poonam Acharya, P. K. Yadav, Paras Rajbhandari
Introduction: Though laparoscopic cholecystectomy is a gold standard treatment for symptomatic cholelithiasis, safe dissection of Calot's triangle is important to avoid major complications like injury to bile duct, vessels and nearby organs. Aims: This study was designed to determine the frequency, description of Rouviere’s sulcus and its role in safe laparoscopic cholecystectomy. Methods:This prospective cross-sectional study was conducted at the Department of Surgery, Karuna Hospital, Nepal from January 2022 to September 2022. Patients who underwent laparoscopic cholecystectomy, presence of Rouviere’s sulcus were identified and classified, kept in Group A and absent in Group B. If the common bile duct outline visualized, its relation with Rouviere’s sulcus was noted and used as reference point for gall bladder dissection. The perioperative complications, conversion to open procedure, operative time and hospital stay were recorded. Results: Among 100 patients, the Rouviere’s sulcus was present in 79% and absent in 21%. Type I is the most common (65.82%). It was found above the level of common bile duct line in 84.81%. Cystic artery injury was present in 1.26% (Group A) and 14.28% (Group B). Bile/stone spillage 1.26% (Group A) and 9.52% (Group B), port hematoma 2.52% (Group A) and 9.52% (Group B), operative time 43.17±8.57 minutes (Group A) and 61.29±12.07 minutes (Group B), conversion to open procedure was none in Group A and 9.52% (Group B) and hospital stay 1.23±0.59 days in group A and 3.16±1.16 days in Group B. Conclusion: Rouviere’s sulcus is an important extrabiliary anatomical landmark, seen in majority of patients for safe laparoscopic cholecystectomy.
{"title":"Rouviere’s Sulcus: An Important Anatomical Landmark in Laparoscopic Cholecystectomy","authors":"S. Bhattarai, Poonam Acharya, P. K. Yadav, Paras Rajbhandari","doi":"10.3126/jngmc.v20i2.51835","DOIUrl":"https://doi.org/10.3126/jngmc.v20i2.51835","url":null,"abstract":"Introduction: Though laparoscopic cholecystectomy is a gold standard treatment for symptomatic cholelithiasis, safe dissection of Calot's triangle is important to avoid major complications like injury to bile duct, vessels and nearby organs. \u0000Aims: This study was designed to determine the frequency, description of Rouviere’s sulcus and its role in safe laparoscopic cholecystectomy. \u0000Methods:This prospective cross-sectional study was conducted at the Department of Surgery, Karuna Hospital, Nepal from January 2022 to September 2022. Patients who underwent laparoscopic cholecystectomy, presence of Rouviere’s sulcus were identified and classified, kept in Group A and absent in Group B. If the common bile duct outline visualized, its relation with Rouviere’s sulcus was noted and used as reference point for gall bladder dissection. The perioperative complications, conversion to open procedure, operative time and hospital stay were recorded. \u0000Results: Among 100 patients, the Rouviere’s sulcus was present in 79% and absent in 21%. Type I is the most common (65.82%). It was found above the level of common bile duct line in 84.81%. Cystic artery injury was present in 1.26% (Group A) and 14.28% (Group B). Bile/stone spillage 1.26% (Group A) and 9.52% (Group B), port hematoma 2.52% (Group A) and 9.52% (Group B), operative time 43.17±8.57 minutes (Group A) and 61.29±12.07 minutes (Group B), conversion to open procedure was none in Group A and 9.52% (Group B) and hospital stay 1.23±0.59 days in group A and 3.16±1.16 days in Group B. \u0000Conclusion: Rouviere’s sulcus is an important extrabiliary anatomical landmark, seen in majority of patients for safe laparoscopic cholecystectomy.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127482325","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 : 2022-12-31DOI: 10.3126/jngmc.v20i2.51833
S. Shakya, Preeti Vaidya, B. Paudel
Introduction: Opioids have been used as a part of balanced anaesthesia and have known side effects. Opioid Free Analgesia is an emerging technique, based on avoiding intraoperative opioids. Aims: To compare the effectiveness of opioid-free versus opioid based anaesthesia. Methods: This comparative study involved 100 patients undergoing elective laparoscopic cholecystectomy under general anaesthesia with American Society of Anaesthesiologists I or II physical status. Out of 100 patients, 50 received Fentanyl (Group A) while another 50 (Group B) received Ketamine and Lignocaine. Parameters measured and compared were the gender, age, weight, ASA physical status, hemodynamic stability, postoperative pain intensity (VAS) and opioid requirements, as well as side effects. Results: Both groups were comparable with regards to age, gender, weight, American Society of Anaesthesiologists I or II physical status, mean duration of surgery. There was no significant difference between groups hemodynamics at all assessed times (p>0.05) intraoperatively. Visual Analogue Scale pain score in the first 24 hours postoperatively showed that patients in Group A, at all analyzed time points had higher Visual Analogue Scale scores than Group B, but statistically significant difference was confirmed during the first hour (p = 0.001). Seven(14%) in Group A and 5(10%) patients in Group B got intravenous tramadol only once while 5(10%) patients in Group A required twice, which was statistically significant (p=0.05). Intraoperatively, 2 patients (4%) in group A had bradycardia while none in group B, which was statistically insignificant (p=0.153). Postoperatively, nausea was more in group A than Group B i.e. 8% vs 4% (p=0.4). Conclusion: Opioid Free anaesthesia has a better benefit over Opioid anaesthesia with regard to postoperative pain score, opioid consumption and its side effects.
{"title":"Comparative Study of Opioid Free versus Opioid Anaesthesia in Patients Undergoing Laparoscopic Cholecystectomy","authors":"S. Shakya, Preeti Vaidya, B. Paudel","doi":"10.3126/jngmc.v20i2.51833","DOIUrl":"https://doi.org/10.3126/jngmc.v20i2.51833","url":null,"abstract":"Introduction: Opioids have been used as a part of balanced anaesthesia and have known side effects. Opioid Free Analgesia is an emerging technique, based on avoiding intraoperative opioids. \u0000Aims: To compare the effectiveness of opioid-free versus opioid based anaesthesia. \u0000Methods: This comparative study involved 100 patients undergoing elective laparoscopic cholecystectomy under general anaesthesia with American Society of Anaesthesiologists I or II physical status. Out of 100 patients, 50 received Fentanyl (Group A) while another 50 (Group B) received Ketamine and Lignocaine. Parameters measured and compared were the gender, age, weight, ASA physical status, hemodynamic stability, postoperative pain intensity (VAS) and opioid requirements, as well as side effects. \u0000Results: Both groups were comparable with regards to age, gender, weight, American Society of Anaesthesiologists I or II physical status, mean duration of surgery. There was no significant difference between groups hemodynamics at all assessed times (p>0.05) intraoperatively. Visual Analogue Scale pain score in the first 24 hours postoperatively showed that patients in Group A, at all analyzed time points had higher Visual Analogue Scale scores than Group B, but statistically significant difference was confirmed during the first hour (p = 0.001). Seven(14%) in Group A and 5(10%) patients in Group B got intravenous tramadol only once while 5(10%) patients in Group A required twice, which was statistically significant (p=0.05). Intraoperatively, 2 patients (4%) in group A had bradycardia while none in group B, which was statistically insignificant (p=0.153). Postoperatively, nausea was more in group A than Group B i.e. 8% vs 4% (p=0.4). \u0000Conclusion: Opioid Free anaesthesia has a better benefit over Opioid anaesthesia with regard to postoperative pain score, opioid consumption and its side effects.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116259392","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 : 2022-12-31DOI: 10.3126/jngmc.v20i2.51836
Dipendra Kc, D. Shrestha, P. Karki, S. Shrestha, Sushil Yogi
Introduction: Isolated ulnar shaft are uncommon injuries with most of the fractures occurring following direct trauma. Open reduction and internal fixation with plating is the gold standard treatment but is associated with complications. Treatment with square nail provides rotational stability, is cheaper, safer with minimum complications of plating. Aims: To evaluate the functional outcome of isolated fracture of middle third to distal third ulna treated with square nail. Methods: This prospective observational study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur from September 2018 to August 2022. Patients aged above 18 and below 60 years who had displaced isolated fracture of middle third or distal third of ulna were evaluated for demographic details, union, functional outcome and associated complications. All of the fractures of ulna were treated by square nail and outcomes were evaluated using disability of arm, shoulder and hand (DASH) score and Grace and Eversmann scoring system. Results: In this study of 39 patients with the mean age of 30.84±8.12 years, 56.4% of the patients were in age group 18-30 years, 27 (69.2%) were males and 12 (30.8%) were females. The right limb was fractured in majority, distal third was more commonly involved, physical assault was the most common mode of injury, transverse was the most common fracture pattern. The average time to union was 11.61±2.74 weeks. Most (74.4%) of the patients had good result in DASH score and most (94.9%) had good to excellent result in Grace and Eversmannscoring at final follow-up. The most common complication noted was olecranon bursitis (17.94%) followed by skin irritation (12.82%). Conclusion: Square nail fixation of isolated middle third to distal third ulna is safe procedure with few complications, produces excellent to good results.
{"title":"Functional Outcome of Isolated Middle to Distal Third Ulnar Shaft Fracture in Adults with Square Nail Fixation","authors":"Dipendra Kc, D. Shrestha, P. Karki, S. Shrestha, Sushil Yogi","doi":"10.3126/jngmc.v20i2.51836","DOIUrl":"https://doi.org/10.3126/jngmc.v20i2.51836","url":null,"abstract":"Introduction: Isolated ulnar shaft are uncommon injuries with most of the fractures occurring following direct trauma. Open reduction and internal fixation with plating is the gold standard treatment but is associated with complications. Treatment with square nail provides rotational stability, is cheaper, safer with minimum complications of plating. \u0000Aims: To evaluate the functional outcome of isolated fracture of middle third to distal third ulna treated with square nail. \u0000Methods: This prospective observational study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur from September 2018 to August 2022. Patients aged above 18 and below 60 years who had displaced isolated fracture of middle third or distal third of ulna were evaluated for demographic details, union, functional outcome and associated complications. All of the fractures of ulna were treated by square nail and outcomes were evaluated using disability of arm, shoulder and hand (DASH) score and Grace and Eversmann scoring system. \u0000Results: In this study of 39 patients with the mean age of 30.84±8.12 years, 56.4% of the patients were in age group 18-30 years, 27 (69.2%) were males and 12 (30.8%) were females. The right limb was fractured in majority, distal third was more commonly involved, physical assault was the most common mode of injury, transverse was the most common fracture pattern. The average time to union was 11.61±2.74 weeks. Most (74.4%) of the patients had good result in DASH score and most (94.9%) had good to excellent result in Grace and Eversmannscoring at final follow-up. The most common complication noted was olecranon bursitis (17.94%) followed by skin irritation (12.82%). \u0000Conclusion: Square nail fixation of isolated middle third to distal third ulna is safe procedure with few complications, produces excellent to good results.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125400587","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 : 2022-12-31DOI: 10.3126/jngmc.v20i2.51838
B. Adhikari
Introduction: Appendicitis is the inflammation of vermiform appendix, one of the most frequent diagnoses for emergency department visits, resulting in hospitalization. Accurate and prompt diagnosis of acute appendicitis may reduce the incidence of morbidity and mortality resulting from perforation and other gravid complications. Aims:To evaluate the effectiveness of Alvarado scoring system in preoperative diagnosis of acute appendicitis. Methods: The study of 100 patients attending to Nepalgunj Medical College and Hospital during the year August 2021 to July 2022, with symptoms of acute appendicitis were included. The Alvarado score for each patient was evaluated. All the subjects included were scheduled for open appendicectomy and the specimens were subjected for histopathological evaluation. Patients with score less than 7 were categorized as Group A, whereas greater than 7 were categorized as Group B. Results: Among 100 patients, there were 58 males and 42 females. Symptoms like pain in right iliac fossa (97%), nausea and vomiting (85%) and anorexia (41%) were common. Positive signs were tenderness in right iliac fossa (92%) and fever (53.5%) with leukocytosis (73%) and neutrophilia in 62 cases (88%). Of 100 patients 27 belonged to Group A, whereas 73 belonged to Group B. 17 patients out of 27 in Group A were diagnosed with acute appendicitis on histology, whereas, 10 showed negative results. 69 out of 73 subjects in Group B were diagnosed with acute appendicitis on histology, whereas 4 showed negative results on histology. The rate of negative appendectomy was significantly higher in group A than group B. The overall sensitivity, specificity, positive predictive value, negative predictive value were 80.20%, 71.42%, 84.52% and 37.03% respectively. Conclusion: The Alvarado score when more than 7 enables risk determination in patients presenting with abdominal pain, linking the probability of appendicitis.
{"title":"Alvarado Score: A Promising Tool in Diagnosis of Acute Appendicitis","authors":"B. Adhikari","doi":"10.3126/jngmc.v20i2.51838","DOIUrl":"https://doi.org/10.3126/jngmc.v20i2.51838","url":null,"abstract":"Introduction: Appendicitis is the inflammation of vermiform appendix, one of the most frequent diagnoses for emergency department visits, resulting in hospitalization. Accurate and prompt diagnosis of acute appendicitis may reduce the incidence of morbidity and mortality resulting from perforation and other gravid complications. \u0000Aims:To evaluate the effectiveness of Alvarado scoring system in preoperative diagnosis of acute appendicitis. \u0000Methods: The study of 100 patients attending to Nepalgunj Medical College and Hospital during the year August 2021 to July 2022, with symptoms of acute appendicitis were included. The Alvarado score for each patient was evaluated. All the subjects included were scheduled for open appendicectomy and the specimens were subjected for histopathological evaluation. Patients with score less than 7 were categorized as Group A, whereas greater than 7 were categorized as Group B. \u0000Results: Among 100 patients, there were 58 males and 42 females. Symptoms like pain in right iliac fossa (97%), nausea and vomiting (85%) and anorexia (41%) were common. Positive signs were tenderness in right iliac fossa (92%) and fever (53.5%) with leukocytosis (73%) and neutrophilia in 62 cases (88%). Of 100 patients 27 belonged to Group A, whereas 73 belonged to Group B. 17 patients out of 27 in Group A were diagnosed with acute appendicitis on histology, whereas, 10 showed negative results. 69 out of 73 subjects in Group B were diagnosed with acute appendicitis on histology, whereas 4 showed negative results on histology. The rate of negative appendectomy was significantly higher in group A than group B. The overall sensitivity, specificity, positive predictive value, negative predictive value were 80.20%, 71.42%, 84.52% and 37.03% respectively. \u0000Conclusion: The Alvarado score when more than 7 enables risk determination in patients presenting with abdominal pain, linking the probability of appendicitis.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129227338","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 : 2022-07-31DOI: 10.3126/jngmc.v20i1.48320
A. Gupta, Lekhanath Baral, G. J. Shah
Introduction: Kidney is an important retroperitoneal organ with excretory and endocrine functions. The length of kidney is affected in variety of clinical disorders with age. Aims: The aim of the study was to determine the renal length with respect to individual’s sex and age. Methods: This study was conducted on 369 patients referred to department of Radiology for abdominal ultrasonographic examination where renal length was measured and recorded. Results: The mean right kidney length was found to be 9.3403 cm and the left mean kidney length was found to be 9.3490 cm. In comparison among male and female, males were found to have a greater mean kidney length. The maximum mean right kidney length was found in 50-59 years age groups while left kidney length was found maximum in 30-39 years age group. Conclusion: We performed ultrasonographic assessment of renal length with respect to age and sex in Nepalese population. We found that the kidney length of both left and right kidneys was related to age and sex.
{"title":"Ultrasonographic Assessment of Renal Length with Respect to Age and Sex: A Hospital Based Study","authors":"A. Gupta, Lekhanath Baral, G. J. Shah","doi":"10.3126/jngmc.v20i1.48320","DOIUrl":"https://doi.org/10.3126/jngmc.v20i1.48320","url":null,"abstract":"Introduction: Kidney is an important retroperitoneal organ with excretory and endocrine functions. The length of kidney is affected in variety of clinical disorders with age. \u0000Aims: The aim of the study was to determine the renal length with respect to individual’s sex and age. \u0000Methods: This study was conducted on 369 patients referred to department of Radiology for abdominal ultrasonographic examination where renal length was measured and recorded. \u0000Results: The mean right kidney length was found to be 9.3403 cm and the left mean kidney length was found to be 9.3490 cm. In comparison among male and female, males were found to have a greater mean kidney length. The maximum mean right kidney length was found in 50-59 years age groups while left kidney length was found maximum in 30-39 years age group. \u0000Conclusion: We performed ultrasonographic assessment of renal length with respect to age and sex in Nepalese population. We found that the kidney length of both left and right kidneys was related to age and sex.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"192 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121102180","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 : 2022-07-31DOI: 10.3126/jngmc.v20i1.48243
S. Shakya, Preeti Vaidya, B. Paudel
Introduction: Pain during injection of propofol continues to be a major discomfort for patients. Different propofol formulations have been introduced to reduce the incidence of pain. Aims: To know the incidence, severity of pain at induction and post operative amnesic effect of two different formulations of propofol. Methods: This double-blinded comparative study involved randomly selected 100 patients undergoing elective surgery under general anesthesia with physical status score I or II (American Society of Anesthesiologists). Out of 100 patients, 50 received medium and long chain triglyceride Propofol (Group A) while another 50 received nanoemulsion Propofol (Group B) intravenously. Parameters measured and compared were the gender, age, weight, physical status score, pain on injection and postoperative recall of pain during injection of propofol. Results: Both groups were comparable with regards to age, gender, physical status score, mean duration of surgery. The presence of pain during injection with propofol in group A was 76% (38 patients) while 36% (18 patients) in group B which was statistically significant (p =0.0001). Severity of pain was more in group A which was statistically significant in comparison to group B (p=0.0001). The arm withdrawal during the injection of propofol was found more in Group A than Group B, 24% vs 0% (p=0.0002). Recall of pain after 4 hours postoperatively was found in 5 patients of Group A (10%) and 3 patients of Group B (6%) which came out to be statistically insignificant (p=0.715). There was no significant difference between groups regarding heart rate, mean arterial pressure, respiratory rate and arterial hemoglobin oxygenation at all assessed times (p > 0.05) intraoperatively. Conclusion: This study clearly shows the incidence and severity of pain on intravenous administration in nanoemulsion Propofol is significantly less. However, amnestic effect was equally present in both the groups.
{"title":"Comparative Study of Pain on Injection of Propofol MCT-LCT with Propofol Nanoemulsion for General Anaesthesia","authors":"S. Shakya, Preeti Vaidya, B. Paudel","doi":"10.3126/jngmc.v20i1.48243","DOIUrl":"https://doi.org/10.3126/jngmc.v20i1.48243","url":null,"abstract":"Introduction: Pain during injection of propofol continues to be a major discomfort for patients. Different propofol formulations have been introduced to reduce the incidence of pain. \u0000Aims: To know the incidence, severity of pain at induction and post operative amnesic effect of two different formulations of propofol. \u0000Methods: This double-blinded comparative study involved randomly selected 100 patients undergoing elective surgery under general anesthesia with physical status score I or II (American Society of Anesthesiologists). Out of 100 patients, 50 received medium and long chain triglyceride Propofol (Group A) while another 50 received nanoemulsion Propofol (Group B) intravenously. Parameters measured and compared were the gender, age, weight, physical status score, pain on injection and postoperative recall of pain during injection of propofol. \u0000Results: Both groups were comparable with regards to age, gender, physical status score, mean duration of surgery. The presence of pain during injection with propofol in group A was 76% (38 patients) while 36% (18 patients) in group B which was statistically significant (p =0.0001). Severity of pain was more in group A which was statistically significant in comparison to group B (p=0.0001). The arm withdrawal during the injection of propofol was found more in Group A than Group B, 24% vs 0% (p=0.0002). Recall of pain after 4 hours postoperatively was found in 5 patients of Group A (10%) and 3 patients of Group B (6%) which came out to be statistically insignificant (p=0.715). There was no significant difference between groups regarding heart rate, mean arterial pressure, respiratory rate and arterial hemoglobin oxygenation at all assessed times (p > 0.05) intraoperatively. \u0000Conclusion: This study clearly shows the incidence and severity of pain on intravenous administration in nanoemulsion Propofol is significantly less. However, amnestic effect was equally present in both the groups.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125392496","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 : 2022-07-31DOI: 10.3126/jngmc.v20i1.48347
A. Shrestha, G. J. Shah, Sagar Neupane, R. Shrestha
Introduction: COVID-19 is a new infectious disease for which there is currently no treatment and has become a new threat for the populations. Therefore, it is necessary to explore biomarkers to determine disease severity which may help to identify patient at risk of prolonged intensive care or death. Aims: To evaluate the ability of C-reactive protein to predict the severity of COVID-19 infection. Methods: This study was conducted on 83 patients with COVID-19 admitted at COVID Unit of Nepalgunj Medical College Teaching Hospital, Kohalpur from April 2021 to June 2021. COVID-19 infection was diagnosed by Reverse Transcription Polymerase Chain Reaction of nasopharyngeal or throat Swab. The study population was divided into mild, moderate and severe cases. The data on demographic characteristics, clinical features and laboratory findings were collected and analyzed using SPSS version 26. P value less than 0.05 was taken as significant. Results: The mean levels of C-reactive protein in mild, moderate and severe cases were 2.75 mg/L, 9.87 mg/L and 84.48 mg/L respectively (P value = 0.003). This shows that CRP levels were significantly higher in severe cases and could be used as important biomarker to predict the severity of disease in COVID-19. Conclusion: The serum level of C-reactive protein can predict the severity and progression of disease in patient with COVID-19. Thus, C-reactive protein should be used as a prognostic marker in COVID-19.
{"title":"C-Reactive Protein as a Prognostic Marker in Hospitalized Patients with COVID-19","authors":"A. Shrestha, G. J. Shah, Sagar Neupane, R. Shrestha","doi":"10.3126/jngmc.v20i1.48347","DOIUrl":"https://doi.org/10.3126/jngmc.v20i1.48347","url":null,"abstract":"Introduction: COVID-19 is a new infectious disease for which there is currently no treatment and has become a new threat for the populations. Therefore, it is necessary to explore biomarkers to determine disease severity which may help to identify patient at risk of prolonged intensive care or death. \u0000Aims: To evaluate the ability of C-reactive protein to predict the severity of COVID-19 infection. \u0000Methods: This study was conducted on 83 patients with COVID-19 admitted at COVID Unit of Nepalgunj Medical College Teaching Hospital, Kohalpur from April 2021 to June 2021. COVID-19 infection was diagnosed by Reverse Transcription Polymerase Chain Reaction of nasopharyngeal or throat Swab. The study population was divided into mild, moderate and severe cases. The data on demographic characteristics, clinical features and laboratory findings were collected and analyzed using SPSS version 26. P value less than 0.05 was taken as significant. \u0000Results: The mean levels of C-reactive protein in mild, moderate and severe cases were 2.75 mg/L, 9.87 mg/L and 84.48 mg/L respectively (P value = 0.003). This shows that CRP levels were significantly higher in severe cases and could be used as important biomarker to predict the severity of disease in COVID-19. \u0000Conclusion: The serum level of C-reactive protein can predict the severity and progression of disease in patient with COVID-19. Thus, C-reactive protein should be used as a prognostic marker in COVID-19.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114734420","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 : 2022-07-31DOI: 10.3126/jngmc.v20i1.48322
B. Thapa, N. Gurung
Introduction: Lid laceration is a very common peri-ocular trauma. Regarding the etiology and treatment, it lacks studies in developing nations including Nepal. Aims: To assess the etiological characteristics and treatment outcomes of eyelid laceration. Methods: In this study, 47 cases of traumatic eyelid laceration were consecutively studied and its epidemiology, etiology and treatment outcome were evaluated. Results: The 47 patients were included in the study. The mean age of study population was 26.14 ± 18.02 years. Male: female ratio was 1.6:1. The trauma occurred on road in 34 (72.3%) cases, followed by at home (14.9%), at work place (8.5%) and at entertainment areas (4.2%). The most common mode of injury was road traffic accident (72.3%) followed by fall injury (17%), Physical assault (6.4%) and animal bite (4.3%). The 68.1% of had isolated lid laceration, 12.7% had other adnexal injuries and 10.6% had globe injuries, 8.5% had other facial injuries and only 4.1% had systemic trauma. The partial thickness laceration was observed on 42(89.4%) cases and full thickness laceration on 5 (10.6%) cases. The length of lid laceration ranged from 4- 45 mm (mean ±SD was 14.7±8.3 mm). The 14.9% cases had canalicular laceration. The 85% of the laceration healed without visible scar. Only 4 patients (8.5%) had thick hypertrophic scar. The visual function was intact in 44 patients whereas impaired in 3 patients with accompanying open globe injury. The complications noted were hypertrophic scar (8.6%), wound infection (2.1%), ectropion (2.1%), corneal opacity (2.1%) and phthisis bulbi (2.1%). Conclusion: This study highlights the high-risk people and work place for eyelid laceration and the safety precautions in dangerous settings, including daily and routine work places. Only accompanying open globe injury can damage visual function.
{"title":"Etiological Characteristics and Treatment Outcomes of Eye Lid Laceration: A Hospital Based Prospective Study","authors":"B. Thapa, N. Gurung","doi":"10.3126/jngmc.v20i1.48322","DOIUrl":"https://doi.org/10.3126/jngmc.v20i1.48322","url":null,"abstract":"Introduction: Lid laceration is a very common peri-ocular trauma. Regarding the etiology and treatment, it lacks studies in developing nations including Nepal. \u0000Aims: To assess the etiological characteristics and treatment outcomes of eyelid laceration. \u0000Methods: In this study, 47 cases of traumatic eyelid laceration were consecutively studied and its epidemiology, etiology and treatment outcome were evaluated. \u0000Results: The 47 patients were included in the study. The mean age of study population was 26.14 ± 18.02 years. Male: female ratio was 1.6:1. The trauma occurred on road in 34 (72.3%) cases, followed by at home (14.9%), at work place (8.5%) and at entertainment areas (4.2%). The most common mode of injury was road traffic accident (72.3%) followed by fall injury (17%), Physical assault (6.4%) and animal bite (4.3%). The 68.1% of had isolated lid laceration, 12.7% had other adnexal injuries and 10.6% had globe injuries, 8.5% had other facial injuries and only 4.1% had systemic trauma. The partial thickness laceration was observed on 42(89.4%) cases and full thickness laceration on 5 (10.6%) cases. The length of lid laceration ranged from 4- 45 mm (mean ±SD was 14.7±8.3 mm). The 14.9% cases had canalicular laceration. The 85% of the laceration healed without visible scar. Only 4 patients (8.5%) had thick hypertrophic scar. The visual function was intact in 44 patients whereas impaired in 3 patients with accompanying open globe injury. The complications noted were hypertrophic scar (8.6%), wound infection (2.1%), ectropion (2.1%), corneal opacity (2.1%) and phthisis bulbi (2.1%). \u0000Conclusion: This study highlights the high-risk people and work place for eyelid laceration and the safety precautions in dangerous settings, including daily and routine work places. Only accompanying open globe injury can damage visual function.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125601000","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 : 2022-07-31DOI: 10.3126/jngmc.v20i1.48318
B. Adhikari, R. Kidwai
Introduction: Almost all ureteric stone migrates from kidney. The drugs commonly used to assist in the passage of bigger calculi include alpha-blockers, calcium channel antagonists, phosphodiesterase inhibitors, corticosteroids. Tamsulosin is an alpha-1 adrenergic receptor antagonist known to augment the stone expulsion rate. Aims: To evaluate the efficacy of Tamsulosin versus fluid therapy in management of urolithiasis. Methods: The study was carried out on 100 patients (divided into 2 groups) at Nepalgunj Medical college Hospital Nepalgunj from May 2020 to April 2021,between 18-50 years of age of either sex, presenting with a symptomatic urinary calculus as demonstrated on imaging. Group 1 received 0.4mg of tablet tamsulosin once daily for 4 weeks, whereas Group 2 fluid therapy for a period of 4 weeks or until expulsion of stone. Results: Group A reflected 88% (40 patients) expulsion rate, whereas Group B reflected 72.0% (36 patients) expulsion rate. There was a statistically significant difference in the expulsion rate amongst both the groups. 92.0% (46 patients) subjects in Group A demonstrated stone expulsion within 4 weeks, mean time being 8 days. In comparison only 70.0% (35 patients) subjects in Group B demonstrated stone expulsion within 4 weeks, mean time being 14 days.Use of tablet diclofenec 100mg was lower in Group A in comparison to Group B. Conclusion: Tamsulosin is a safe and effective pharmacological agent in management of ureteric stones as it known to increase overall stone expulsion rate, reduced stone expulsion time, decrease acute attacks by acting as a spasmolytic, and fewer pain episodes. It may be considered as a conservative therapeutic option before more invasive procedures like ureteroscopic removal or Extracorporeal shock wave lithotripsy.
{"title":"Tamsulosin versus Fluid Therapy in Management of Ureteric Stone: A Comparative Study","authors":"B. Adhikari, R. Kidwai","doi":"10.3126/jngmc.v20i1.48318","DOIUrl":"https://doi.org/10.3126/jngmc.v20i1.48318","url":null,"abstract":"Introduction: Almost all ureteric stone migrates from kidney. The drugs commonly used to assist in the passage of bigger calculi include alpha-blockers, calcium channel antagonists, phosphodiesterase inhibitors, corticosteroids. Tamsulosin is an alpha-1 adrenergic receptor antagonist known to augment the stone expulsion rate. \u0000Aims: To evaluate the efficacy of Tamsulosin versus fluid therapy in management of urolithiasis. \u0000Methods: The study was carried out on 100 patients (divided into 2 groups) at Nepalgunj Medical college Hospital Nepalgunj from May 2020 to April 2021,between 18-50 years of age of either sex, presenting with a symptomatic urinary calculus as demonstrated on imaging. Group 1 received 0.4mg of tablet tamsulosin once daily for 4 weeks, whereas Group 2 fluid therapy for a period of 4 weeks or until expulsion of stone. \u0000Results: Group A reflected 88% (40 patients) expulsion rate, whereas Group B reflected 72.0% (36 patients) expulsion rate. There was a statistically significant difference in the expulsion rate amongst both the groups. 92.0% (46 patients) subjects in Group A demonstrated stone expulsion within 4 weeks, mean time being 8 days. In comparison only 70.0% (35 patients) subjects in Group B demonstrated stone expulsion within 4 weeks, mean time being 14 days.Use of tablet diclofenec 100mg was lower in Group A in comparison to Group B. \u0000Conclusion: Tamsulosin is a safe and effective pharmacological agent in management of ureteric stones as it known to increase overall stone expulsion rate, reduced stone expulsion time, decrease acute attacks by acting as a spasmolytic, and fewer pain episodes. It may be considered as a conservative therapeutic option before more invasive procedures like ureteroscopic removal or Extracorporeal shock wave lithotripsy.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134015841","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 : 2022-07-31DOI: 10.3126/jngmc.v20i1.48112
Abhishek Arjel, K. Pokhrel
Introduction: Telogen Effluvium is one of the most common form of diffuse non scarring hair loss, usually occurring three months after a stressful event causing hair shedding. Trichodynia is an imminent and frequent warning sign of Telogen Effluvium. Increasing cases of Telogen Effluvium during COVID-19 era has been found and it should be an alarming sign for a dermatologist and patients who have been infected by COVID-19 in the past. Aims: To study Telogen Effluvium in post COVID-19 patients, onset of Telogen Effluvium and occurrence of Trichodynia in different severity groups of COVID-19. Methods: This casual-comparative study was conducted from January 2021 to December 2021 in total of 52 Telogen Effluvium patients with confirmed recent COVID-19 disease visiting in outpatient department of Dermatology in Nepalgunj Medical College Teaching Hospital. Patient’s with physiological, psychosocial and other chronic illness known to trigger Telogen Effluvium were excluded. Hair pull test was done for diagnosing Telogen Effluvium. Results:The mean age of the study population was 31.0577±11.78 years. There was a female preponderance with 39 (75%). The mean onset of hair loss after COVID-19 infection was 10.05 weeks and was significantly earlier among the higher severity groups. Among the patients with Telogen Effluvium, 16 (30.80%) presented with trichodynia. Kruskal- Wallis test showed that with increase in severity of COVID-19, there was early onset of Telogen Effluvium associated hair loss and increase occurrence of trichodynia with p value of 0.000 for both variables. Conclusion:Telogen Effluvium is common in post COVID patients. Post-COVID Telogen Effluvium is more common in females. The onset of Telogen Effluvium is earlier and is more associated with trichodynia with the increase in severity of COVID-19 during their illness.
{"title":"Telogen Effluvium and Trichodynia in Different Severity Groups of Post COVID-19 Patients","authors":"Abhishek Arjel, K. Pokhrel","doi":"10.3126/jngmc.v20i1.48112","DOIUrl":"https://doi.org/10.3126/jngmc.v20i1.48112","url":null,"abstract":"Introduction: Telogen Effluvium is one of the most common form of diffuse non scarring hair loss, usually occurring three months after a stressful event causing hair shedding. Trichodynia is an imminent and frequent warning sign of Telogen Effluvium. Increasing cases of Telogen Effluvium during COVID-19 era has been found and it should be an alarming sign for a dermatologist and patients who have been infected by COVID-19 in the past. \u0000Aims: To study Telogen Effluvium in post COVID-19 patients, onset of Telogen Effluvium and occurrence of Trichodynia in different severity groups of COVID-19. \u0000Methods: This casual-comparative study was conducted from January 2021 to December 2021 in total of 52 Telogen Effluvium patients with confirmed recent COVID-19 disease visiting in outpatient department of Dermatology in Nepalgunj Medical College Teaching Hospital. Patient’s with physiological, psychosocial and other chronic illness known to trigger Telogen Effluvium were excluded. Hair pull test was done for diagnosing Telogen Effluvium. \u0000Results:The mean age of the study population was 31.0577±11.78 years. There was a female preponderance with 39 (75%). The mean onset of hair loss after COVID-19 infection was 10.05 weeks and was significantly earlier among the higher severity groups. Among the patients with Telogen Effluvium, 16 (30.80%) presented with trichodynia. Kruskal- Wallis test showed that with increase in severity of COVID-19, there was early onset of Telogen Effluvium associated hair loss and increase occurrence of trichodynia with p value of 0.000 for both variables. \u0000Conclusion:Telogen Effluvium is common in post COVID patients. Post-COVID Telogen Effluvium is more common in females. The onset of Telogen Effluvium is earlier and is more associated with trichodynia with the increase in severity of COVID-19 during their illness.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132912608","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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