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Harmless Acute Pancreatitis Score 无害急性胰腺炎评分
Pub Date : 2022-01-16 DOI: 10.3126/jngmc.v19i1.40227
S. Bharti, Anup Sharma
Introduction: Acute Pancreatitis is a common disease in our region. It can range from mild to severe disease with high mortality rate. It is critical to identify patients who are at high risk for a severe disease course, since they require close monitoring and immediate aggressive treatment. Aims: To compare the effectiveness of Harmless Acute Pancreatitis Score with Ranson’s scoring system in predicting the severity of Acute Pancreatitis. Methods: A prospective cross sectional study was done among 45 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. If haematocrit was less than39% in female and less than43% in male, serum creatinine less than two miligram /deciliter and no sign of peritonitis, it was assigned as Harmless Acute Pancreatitis Score Zero. If at least one parameter was abnormal it was assigned as Harmless Acute Pancreatitis Score +. Severe pancreatitis (poor prognosis) was considered in those who required Intensive Care Unit care, who had in hospital mortality and who had hospitalization of more than five days. Patients with on admission Ranson’s score of more than three were suspected to have severe Pancreatitis. Results: There were total 45 patients, 18 females and 27 males. Twenty four patients were assigned as Harmless Acute Pancreatitis Score zero and 21 patients were assigned as Harmless Acute Pancreatitis Score +. Harmless Acute Pancreatitis Score was able to predict correctly in 18 out of 26 patients who fulfilled the criteria of poor prognosis (p<0.001). Conclusion: Harmless Acute Pancreatitis Score proved to be a better screening tool compared to on admission Ranson’s scoring system to predict the severity of Acute Pancreatitis, which may help predict the prognosis of the patient.
简介:急性胰腺炎是本地区的常见病。该病可轻可重,死亡率高。确定有严重病程高风险的患者至关重要,因为他们需要密切监测和立即积极治疗。目的:比较无害急性胰腺炎评分与Ranson评分系统在预测急性胰腺炎严重程度方面的有效性。方法:对45例诊断为急性胰腺炎而在外科住院一年的患者进行前瞻性横断面研究。如果女性红细胞压积小于39%,男性小于43%,血清肌酐小于2毫克/分升,无腹膜炎迹象,则为无害急性胰腺炎评分0分。如果至少有一个参数异常,则为无害急性胰腺炎评分+。严重胰腺炎(预后不良)被认为是需要重症监护病房护理的患者、住院死亡率和住院时间超过5天的患者。入院时Ranson评分大于3分的患者被怀疑患有严重胰腺炎。结果:共45例患者,其中女性18例,男性27例。无害性急性胰腺炎评分0分24例,无害性急性胰腺炎评分+分21例。26例符合不良预后标准的患者中,18例无害性急性胰腺炎评分能够正确预测(p<0.001)。结论:与入院时Ranson评分系统相比,无害化急性胰腺炎评分是一种更好的预测急性胰腺炎严重程度的筛查工具,有助于预测患者的预后。
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引用次数: 0
Correlation between McIssac Score and Throat Swab Culture in Patient Presenting with Acute Tonsillitis 急性扁桃体炎患者McIssac评分与咽拭子培养的相关性
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42994
S. Bhandari, D. Paudel, K. Gurung
Introduction: Tonsillitis is inflammation of tonsils which is characterized by various signs and symptoms with sore throat being the most consistent symptom. The condition is mostly caused by bacterial infection with Streptococci being the most common bacteria. McIssac scoring technique is clinical symptoms based scoring method designed for diagnosing streptococcal tonsillitis.Aims: To find out the association between McIssac Score and beta hemolytic streptococcal infection in acute tonsillitis.Methods: This hospital based, prospective study was carried out in the Department of ENT, Nepalgunj Medical College from July 2020 to June 2021. Patients were scored as per McIssac score. The specimens were collected from the tonsillar surface using sterile cotton swabs and subjected for culture and sensitivity.Results:The most common affected age group was 21 to 30 years (46%). Females were affected more commonly (57%). The most common organism isolated in the study was Group A beta hemolyticn Streptococcus (48%), followed by Pseudomonas (10%), Enterococcus (9%) and Klebsiella (8%) and no organisms were isolated in 25% of the patients. It was observed that high McIssac score was associated with higher chance of having positive beta hemolytic streptococcal infection. Out of 48 group A beta hemolytic streptococci culture positive patients 18(37.5%) patients scored 3, 9 (18.75%) patients scored 4 and 7(14.5%) patients scored 5.The most common antibiotic effective against group A beta hemolytic srtreptococci was ceftriaxone in 25(72.9%), followed by amoxyclavulinic acid in 20 isolates (41.6%) and amikacin in seventeen (35.4%) isolates.Conclusion: The correlation between throat swab culture and McIssac score emphasized that this clinical scoring system aid in early diagnosis of group A beta hemolytic streptococci tonsillitis.
简介:扁桃体炎是扁桃体的炎症,具有多种体征和症状,以喉咙痛为最一致的症状。这种情况主要是由细菌感染引起的,链球菌是最常见的细菌。McIssac评分法是一种基于临床症状的诊断链球菌扁桃体炎的评分方法。目的:探讨急性扁桃体炎患者McIssac评分与乙型溶血性链球菌感染的关系。方法:于2020年7月至2021年6月在尼泊尔医学院耳鼻喉科开展以医院为基础的前瞻性研究。按照McIssac评分对患者进行评分。用无菌棉签从扁桃体表面采集标本,进行培养和敏感性试验。结果:21 ~ 30岁最常见(46%)。女性更常见(57%)。本研究中分离到的最常见的微生物是A群β溶血性链球菌(48%),其次是假单胞菌(10%)、肠球菌(9%)和克雷伯氏菌(8%),25%的患者未分离到微生物。我们观察到,高McIssac评分与较高的机会有阳性溶血性链球菌感染。48例A组溶血性链球菌培养阳性患者中,18例(37.5%)患者得分为3分,9例(18.75%)患者得分为4分,7例(14.5%)患者得分为5分。对A组溶血性链球菌最有效的抗生素是头孢曲松25株(72.9%),其次是阿莫克拉维酸20株(41.6%)和阿米卡星17株(35.4%)。结论:咽拭子培养与McIssac评分的相关性强调了该临床评分系统有助于A组溶血性链球菌扁桃体炎的早期诊断。
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引用次数: 0
Outcome of Management of Pediatric Subtrochanteric Femoral Fracture with Broad Dynamic Compression Plate and Proximal Cancellous Screw through the Femoral Neck 经股骨颈宽动力加压钢板联合近端松质螺钉治疗小儿股骨粗隆下骨折的疗效
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42987
P. Karki, D. Shrestha, Roshani Ranabhat
Introduction: Pediatric subtrochanteric femoral fracture can be managed with traction followed by spica, intramedullary elastic nailing, plating or external fixators. The prognosis largely depends on adequate reduction and stable fixation.Aims:The aim of this study was to evaluate functional outcome of pediatric subtrochanteric femoral fracture treated with broad dynamic compression plate.Methods: This prospective observational study consisted of 32 children between the age 7 to 15 years, with an average of 10.06 years ± 2.29, with subtrochanteric femoral fracture. Fractures were reduced by an open reduction through lateral approach and stabilized with a broad dynamic compression plate along with a proximal cancellous screw through the femoral neck. All patients were followed for 15 months and the results were evaluated on the basis of Flynn scoring system.Results: All fractures united with a mean duration of 12.6 weeks ± 0.91. Average hospital stay was 8.43 days (5 to 14 days). Functional outcome was excellent in 84.38% (27 patients) and satisfactory in 15.62% (5 patients). Full weight bearing was started after mean duration of 16.62 weeks ± 0.91. Implants were removed at an average of 11.21 months ± 1.06. There were no significant limb length discrepancies, deep infections, re-fracture, osteomyelitis and avascular necrosis.Conclusion: This prospective study showed good functional outcome in pediatric patients having subtrochanteric femoral fractures who were treated with a broad dynamic compression plate and a proximal cancellous screw through neck.
儿童股骨粗隆下骨折可采用牵引后加骨钉、髓内弹性钉、钢板或外固定架治疗。预后很大程度上取决于充分复位和稳定固定。目的:本研究的目的是评估儿童股骨粗隆下骨折采用宽动态加压钢板治疗的功能结果。方法:本前瞻性观察研究纳入32例7 ~ 15岁的儿童,平均年龄10.06±2.29岁,股骨粗隆下骨折。骨折通过外侧入路切开复位复位,并通过股骨颈近端松质螺钉固定宽动态加压钢板。所有患者随访15个月,采用Flynn评分系统对结果进行评价。结果:所有骨折均愈合,平均时间12.6周±0.91周。平均住院时间为8.43天(5 ~ 14天)。功能预后优良率为84.38%(27例),满意率为15.62%(5例)。平均持续时间16.62周±0.91周后开始完全负重。种植体移除时间平均为11.21个月±1.06个月。无明显的肢体长度差异、深部感染、再骨折、骨髓炎和无血管性坏死。结论:这项前瞻性研究显示,采用宽动态加压钢板和近端松质螺钉穿过颈部治疗股骨粗隆下骨折的儿童患者功能预后良好。
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引用次数: 0
Effectiveness of Modified Tension Band Wiring for Medial Mallelous Fracture of Tibia 改良张力带钢丝治疗胫骨内侧腓骨骨折疗效观察
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42998
Dipendra Kc, D. Shrestha, P. Karki, Sushil Yogi
Introduction: Medial malleolus fracture is one of the commonest fractures. Non-operative approach may fail to produce anatomical reduction leading to ankle instability, nonunion and post traumatic osteoarthritis of the ankle. Proper anatomical reduction and stable internal fixation remains the key in treatment of displaced fracture. Good result had been achieved with Modified Tension Band Wiring.Aims:The purpose of our study was to evaluate the functional outcome of medial malleolus fracture treated with modified tension band wiring.Methods:This prospective observational study was conducted in department of Orthopaedics of Nepalgunj Medical College and Teaching Hospital from September 2018 to August 2021. Patients were evaluated for mode of injury, type of fracture, associated injury, radiological union, functional outcome, accompanying complications. All of the medial malleolus fractures in this study were treated by modified tension band wiring and outcomes were evaluated using Olerud and Molander Score.Results: In this study of 40 patients with the mean age of 41.60+13.75 year, 31(77.5%) were male and 9 (22.5%) were female. Majority of fractures were observed between 35 to 44 years, right side was predominantly involved, road traffic accident was the most common mode of injury. The average time duration of surgery from the time of injury was 5.25 days. Final functional outcome as per Olerud and Molander score showed, seven (17.5%) patients had excellent results, 30 (75%) patients had good results and three (7.5%) patients had poor results. The most common complication noted was hardware prominence at 7.5%, followed by superficial wound infection in 5% of patients.Conclusion: Modified Tension band wiring of medial malleolus results in good to excellent outcome in most of the patients with few complications .
内踝骨折是最常见的骨折之一。非手术入路可能无法实现解剖复位,导致踝关节不稳定、骨不连和创伤后踝关节骨关节炎。适当的解剖复位和稳定的内固定仍然是治疗移位性骨折的关键。改进张力带布线方法取得了良好的效果。目的:我们研究的目的是评估改良张力带钢丝治疗内踝骨折的功能结果。方法:本前瞻性观察研究于2018年9月至2021年8月在尼泊尔医学院及教学医院骨科进行。对患者的损伤方式、骨折类型、相关损伤、放射愈合、功能结局和伴随并发症进行评估。本研究中所有内踝骨折均采用改良张力带钢丝治疗,并采用Olerud和Molander评分评估结果。结果:本组患者40例,平均年龄41.60+13.75岁,男性31例(77.5%),女性9例(22.5%)。骨折多发生在35 ~ 44岁之间,以右侧为主,道路交通事故是最常见的损伤方式。手术时间自损伤时起平均为5.25天。根据Olerud和Molander评分,最终功能预后为优7例(17.5%),良30例(75%),差3例(7.5%)。最常见的并发症是硬体突出(7.5%),其次是浅表伤口感染(5%)。结论:改良内踝张力带钢丝术多数患者疗效良好,并发症少。
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引用次数: 0
Comparative Study between Conservative Management and Appendectomy in Appendicular Lump in Children 儿童阑尾肿块保守治疗与阑尾切除术的比较研究
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42859
Feeroz Alam Khan, N. Paudel, P. Maharjan
Introduction: Acute appendicitis is the most common presentation in the pediatric emergency department. Presentation ranges from mild inflammation to perforation and peritonitis. Frequently, patients present late with lump formation. Traditionally, an appendicular lump is managed conservatively followed by interval appendectomy six weeks later when the inflammation has resolved.Aims: This study was designed to evaluate the outcome of early appendectomy in cases of appendicular lump and their complications compared to the conventional method of conservative management followed by interval appendectomy.Methods: A prospective comparative study was conducted between November 2018 and October 2021. All the patients with appendicular lump of up to 7 days duration diagnosed clinically or by ultrasonography were randomly divided into two groups. Group I patients were conservatively managed as per the Ochsner-Sherren regimen. Patients in Group II were operated within 24 hours of admission. Mean operative time was recorded in each case. Complications following the respective interventions were observed.Results: Sixty-two patients of which 42 males and 20 females were diagnosed to have an appendicular lump. The age of the patients ranged from seven to 15 years. Duration of onset ranged from three to seven days at the time of presentation in the emergency room. All the patients in Group I except two patients underwent conservative management. There were four readmissions among Group I patients and one in Group II. The average operating time was 67 minutes for patients undergoing open appendectomy. Complications following surgery were more in patients presenting with history of over five days duration. Group I patients had a comparatively greater number of hospital admission days compared to Group II (7.1 and 4.8 days).Conclusion: The appendicular lump can be explored early as it confirms the diagnosis, shortens the financial burden and hospital stay and avoids follow-up visits for interval surgery.
简介:急性阑尾炎是儿科急诊科最常见的症状。表现从轻度炎症到穿孔和腹膜炎。通常,患者出现肿块形成较晚。传统上,阑尾肿块是保守处理,然后在炎症消退后6周进行间歇阑尾切除术。目的:本研究旨在评价早期阑尾切除术治疗阑尾肿块的效果及其并发症,并与常规保守治疗后间隔阑尾切除术进行比较。方法:2018年11月至2021年10月进行前瞻性比较研究。所有经临床或超声诊断为阑尾肿块持续7 d以上的患者随机分为两组。第一组患者按照Ochsner-Sherren方案进行保守治疗。第二组患者在入院24小时内手术。记录每个病例的平均手术时间。观察各自干预后的并发症。结果:62例患者确诊为阑尾肿块,其中男42例,女20例。患者年龄从7岁到15岁不等。在急诊室就诊时,发病时间从3天到7天不等。I组除2例患者外均行保守治疗。1组4例再入院,2组1例再入院。开腹阑尾切除术的平均手术时间为67分钟。病程超过5天的患者术后并发症较多。与II组相比,I组患者的住院天数相对较多(7.1天和4.8天)。结论:阑尾肿块可早期探查,明确诊断,缩短经济负担和住院时间,避免间隔手术随访。
{"title":"Comparative Study between Conservative Management and Appendectomy in Appendicular Lump in Children","authors":"Feeroz Alam Khan, N. Paudel, P. Maharjan","doi":"10.3126/jngmc.v19i2.42859","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42859","url":null,"abstract":"Introduction: Acute appendicitis is the most common presentation in the pediatric emergency department. Presentation ranges from mild inflammation to perforation and peritonitis. Frequently, patients present late with lump formation. Traditionally, an appendicular lump is managed conservatively followed by interval appendectomy six weeks later when the inflammation has resolved.\u0000Aims: This study was designed to evaluate the outcome of early appendectomy in cases of appendicular lump and their complications compared to the conventional method of conservative management followed by interval appendectomy.\u0000Methods: A prospective comparative study was conducted between November 2018 and October 2021. All the patients with appendicular lump of up to 7 days duration diagnosed clinically or by ultrasonography were randomly divided into two groups. Group I patients were conservatively managed as per the Ochsner-Sherren regimen. Patients in Group II were operated within 24 hours of admission. Mean operative time was recorded in each case. Complications following the respective interventions were observed.\u0000Results: Sixty-two patients of which 42 males and 20 females were diagnosed to have an appendicular lump. The age of the patients ranged from seven to 15 years. Duration of onset ranged from three to seven days at the time of presentation in the emergency room. All the patients in Group I except two patients underwent conservative management. There were four readmissions among Group I patients and one in Group II. The average operating time was 67 minutes for patients undergoing open appendectomy. Complications following surgery were more in patients presenting with history of over five days duration. Group I patients had a comparatively greater number of hospital admission days compared to Group II (7.1 and 4.8 days).\u0000Conclusion: The appendicular lump can be explored early as it confirms the diagnosis, shortens the financial burden and hospital stay and avoids follow-up visits for interval surgery.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"11 21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128529844","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}
引用次数: 0
Comparative Study of Minimally Invasive Percutaneous Plate Osteosynthesis versus Reamed Intramedullary Nail Fixation for Extra Articular Distal Third Tibial Fractures 微创经皮钢板内固定与扩孔髓内钉内固定治疗胫骨第三远端关节外骨折的比较研究
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42991
D. Shrestha, Dipendra Kc, P. Karki, S. Shrestha, Sushil Yogi
Introduction: Extraarticular distal third tibial fractures are highly controversial and difficult to treat despite of numerous methods of fixation. The most common methods of treating these fractures are minimally invasive percutaneous plate osteosynthesis (MIPPO) and reamed intramedullary nailing (RIMN).Aims: The aim of this study is to compare and assess its demographic status, preoperative status and functional outcomes of these two groups of patients with extraarticular distal third tibial fractures.Methods:This prospective hospital based observational study of 36 patients with extra articular distal third tibial fractures was carried out from January 2018 to January 2021 at Nepalgunj Medical College Teaching Hospital, Kohalpur. Thirty-six patients were included in the study and were divided into two groups of 18 each and were treated with MIPPO and RIMN methods and were followed up regularly. Clinical and functional outcome were evaluated at 12 months.Results: Out of 36 patients 20 were male and 16 were female. Mean age was 37.63with SD ± 11.43 years. Twenty two were right sided and 14 were left sided. Mean duration of surgery in MIPPO group was 75.33 with SD ± 14.64minutes and in RIMN group was 98.33with SD ± 18.96 minutes. There were 24 cases of associated fibular fractures. Two cases of surgical site infection and two cases of K-wire impingement on fibular side were encountered in MIPPO group whereas three cases of postoperative blisters were seen in RIMN group. All fractures united. The mean average time for fracture healing in MIPPO group was 25.55 weeks and in RIMN group was 27.55 weeks. The clinical and functional outcome were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) scoring system, the mean score in MIPPO group was 91.22 and in RIMN group was 90.77.Conclusion: There was a good outcome in MIPPO group than RIMN group for extra articular distal third tibial fractures.
引言:尽管有许多固定方法,第三胫骨远端关节外骨折仍是一个极具争议和难以治疗的问题。治疗这些骨折最常用的方法是微创经皮钢板内固定术(MIPPO)和扩孔髓内钉(RIMN)。目的:本研究的目的是比较和评估这两组第三胫骨远端关节外骨折患者的人口学状况、术前状态和功能结局。方法:本前瞻性医院观察研究于2018年1月至2021年1月在Kohalpur尼泊尔医学院教学医院对36例胫骨远端关节外骨折患者进行观察。将36例患者分为两组,每组18例,分别采用MIPPO和RIMN方法治疗,并定期随访。12个月时评估临床和功能结果。结果:36例患者中,男性20例,女性16例。平均年龄37.63岁,SD±11.43岁。22个是右边的,14个是左边的。MIPPO组平均手术时间为75.33分钟,SD±14.64分钟;RIMN组平均手术时间为98.33分钟,SD±18.96分钟。伴有腓骨骨折24例。MIPPO组手术部位感染2例,腓骨侧k线撞击2例,RIMN组术后出现3例水疱。所有骨折愈合。MIPPO组平均骨折愈合时间为25.55周,RIMN组平均骨折愈合时间为27.55周。采用美国骨科足踝学会(AOFAS)评分系统进行临床及功能评分,MIPPO组平均评分为91.22分,RIMN组平均评分为90.77分。结论:MIPPO组治疗第三胫骨远端关节外骨折疗效优于RIMN组。
{"title":"Comparative Study of Minimally Invasive Percutaneous Plate Osteosynthesis versus Reamed Intramedullary Nail Fixation for Extra Articular Distal Third Tibial Fractures","authors":"D. Shrestha, Dipendra Kc, P. Karki, S. Shrestha, Sushil Yogi","doi":"10.3126/jngmc.v19i2.42991","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42991","url":null,"abstract":"Introduction: Extraarticular distal third tibial fractures are highly controversial and difficult to treat despite of numerous methods of fixation. The most common methods of treating these fractures are minimally invasive percutaneous plate osteosynthesis (MIPPO) and reamed intramedullary nailing (RIMN).\u0000Aims: The aim of this study is to compare and assess its demographic status, preoperative status and functional outcomes of these two groups of patients with extraarticular distal third tibial fractures.\u0000Methods:This prospective hospital based observational study of 36 patients with extra articular distal third tibial fractures was carried out from January 2018 to January 2021 at Nepalgunj Medical College Teaching Hospital, Kohalpur. Thirty-six patients were included in the study and were divided into two groups of 18 each and were treated with MIPPO and RIMN methods and were followed up regularly. Clinical and functional outcome were evaluated at 12 months.\u0000Results: Out of 36 patients 20 were male and 16 were female. Mean age was 37.63with SD ± 11.43 years. Twenty two were right sided and 14 were left sided. Mean duration of surgery in MIPPO group was 75.33 with SD ± 14.64minutes and in RIMN group was 98.33with SD ± 18.96 minutes. There were 24 cases of associated fibular fractures. Two cases of surgical site infection and two cases of K-wire impingement on fibular side were encountered in MIPPO group whereas three cases of postoperative blisters were seen in RIMN group. All fractures united. The mean average time for fracture healing in MIPPO group was 25.55 weeks and in RIMN group was 27.55 weeks. The clinical and functional outcome were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) scoring system, the mean score in MIPPO group was 91.22 and in RIMN group was 90.77.\u0000Conclusion: There was a good outcome in MIPPO group than RIMN group for extra articular distal third tibial fractures.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126433675","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}
引用次数: 0
Outcome of Pediatric Humerus Fracture Treated With Close Reduction and Elastic Intramedullary Nailing 闭合复位加弹性髓内钉治疗小儿肱骨骨折的疗效
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42993
Sushil Yogi, D. Shrestha, Dipendra Kc, P. Karki, S. Shrestha
Introduction: Pediatric humeral shaft fractures are infrequent fractures only secondary to trauma or any of the pathological changes in the bone; representing two to 5.5% of all pediatric fractures and occurring predominantly in children younger than three years or older than 12 years of age. These fractures can usually be treated conservatively with functional bracing and splints however conditions like inability to maintain an acceptable reduction, open fractures, floating elbow, closed head injury, and polytrauma patient requiring early weight bearing warrant the surgical intervention. The intramedullary elastic nails have been found to be more effective in treating fracture shaft of humerus of pediatric age group in comparison over other implants used.Aims:The aim of this cross-sectional observational study was to evaluate the outcome of shaft of humerus fracture in children treated with retrograde intramedullary kirschner’s wire.Methods: This prospective study was conducted in the department of Orthopedics in Nepalgunj Medical College Teaching, Kohalpur from January 2020 to March 2021 in 26 children. Children were evaluated for age, sex, side of injury, mechanism of injury, time period for union, implant removal time, outcome and accompanying complications. Patients were evaluated using Broberg and Morrey scoring system for elbow functions and modified Dash criteria for shoulder function.Results: In this study of 26 children, 65.4% were boys and 34.6% were girls with average age of 9.58 ± 2.1 years. Left side was prominent side for injury with 69.2%. The average duration for union was found to be 10.04 ± 1.42 weeks. The implant was removed at 24.19 ±1.57 weeks. Based on Broberg and Morrey score system for elbow, 23 (88.46%) children had excellent result and three (11.54%) had good result. While evaluating for Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder joint evaluation; all children had excellent result.Conclusion: The treatment of pediatric humeral shaft fracture by close reduction and intramedullary kirschner’s wire is safe, easy and cost effective operative procedure with good results.
儿童肱骨干骨折是一种罕见的骨折,仅继发于创伤或骨的任何病理改变;占所有儿童骨折的2%至5.5%,主要发生在3岁以下或12岁以上的儿童。这些骨折通常可以用功能性支具和夹板保守治疗,但如无法维持可接受的复位、开放性骨折、漂浮肘关节、闭合性头部损伤和多发创伤患者需要早期负重等情况需要手术干预。髓内弹性钉治疗小儿年龄组肱骨骨折较其他内固定更为有效。目的:本横断面观察研究的目的是评估逆行克氏针治疗儿童肱骨轴骨折的疗效。方法:本前瞻性研究于2020年1月至2021年3月在尼泊尔科尔布尔医学院骨科进行,共26名儿童。评估儿童的年龄、性别、损伤部位、损伤机制、愈合时间、取出种植体时间、结局及伴随并发症。使用Broberg和Morrey评分系统对患者进行肘部功能评估,并使用改进的Dash标准对患者进行肩部功能评估。结果:本组26例患儿中,男孩65.4%,女孩34.6%,平均年龄9.58±2.1岁。左侧损伤为突出部位,占69.2%。平均愈合时间为10.04±1.42周。种植体于24.19±1.57周取出。基于Broberg和Morrey肘部评分系统,23例(88.46%)患儿表现优异,3例(11.54%)患儿表现良好。在评估手臂、肩膀和手的残疾(DASH)评分时,肩关节评估;所有孩子都取得了优异的成绩。结论:闭合复位加克氏针治疗小儿肱骨干骨折是一种安全、简便、经济、效果好的手术方法。
{"title":"Outcome of Pediatric Humerus Fracture Treated With Close Reduction and Elastic Intramedullary Nailing","authors":"Sushil Yogi, D. Shrestha, Dipendra Kc, P. Karki, S. Shrestha","doi":"10.3126/jngmc.v19i2.42993","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42993","url":null,"abstract":"Introduction: Pediatric humeral shaft fractures are infrequent fractures only secondary to trauma or any of the pathological changes in the bone; representing two to 5.5% of all pediatric fractures and occurring predominantly in children younger than three years or older than 12 years of age. These fractures can usually be treated conservatively with functional bracing and splints however conditions like inability to maintain an acceptable reduction, open fractures, floating elbow, closed head injury, and polytrauma patient requiring early weight bearing warrant the surgical intervention. The intramedullary elastic nails have been found to be more effective in treating fracture shaft of humerus of pediatric age group in comparison over other implants used.\u0000Aims:The aim of this cross-sectional observational study was to evaluate the outcome of shaft of humerus fracture in children treated with retrograde intramedullary kirschner’s wire.\u0000Methods: This prospective study was conducted in the department of Orthopedics in Nepalgunj Medical College Teaching, Kohalpur from January 2020 to March 2021 in 26 children. Children were evaluated for age, sex, side of injury, mechanism of injury, time period for union, implant removal time, outcome and accompanying complications. Patients were evaluated using Broberg and Morrey scoring system for elbow functions and modified Dash criteria for shoulder function.\u0000Results: In this study of 26 children, 65.4% were boys and 34.6% were girls with average age of 9.58 ± 2.1 years. Left side was prominent side for injury with 69.2%. The average duration for union was found to be 10.04 ± 1.42 weeks. The implant was removed at 24.19 ±1.57 weeks. Based on Broberg and Morrey score system for elbow, 23 (88.46%) children had excellent result and three (11.54%) had good result. While evaluating for Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder joint evaluation; all children had excellent result.\u0000Conclusion: The treatment of pediatric humeral shaft fracture by close reduction and intramedullary kirschner’s wire is safe, easy and cost effective operative procedure with good results.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131182497","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}
引用次数: 0
Evaluation of Bacterial Co-infections of the Respiratory Tract in COVID-19 Patients COVID-19患者呼吸道细菌合并感染的评价
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.42851
K. Gurung, P. Pant, Sandeep Pokhrel, Dhan Raj Neupane, Samjhana Gurung
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2. The co-evolution of viral and bacterial respiratory pathogens has created an environment in which a viral infection allows concurrent or secondary bacterial co-infections.Aims: This study was carried out to isolate the different respiratory bacterial pathogens from COVID patients and evaluate their antibiotic sensitivity pattern.Methods: Hospital based descriptive cross sectional study was conducted over a period of between 2nd Jestha to 5th Shrawan 2078 (16th May to 20th July 2021) in Nepalgunj Medical college, Kohalpur during the second wave of COVID-19 in Nepal. The sputum was inoculated onto different culture plates such as Blood Agar (BA) and MacConkey Agar (MA) and incubated at 37 oC. After overnight growth and in Gram staining, different Gram’s positive and negative bacteria were observed. Antibiotic sensitivity test was performed by Kirby-Bauer Disk Diffusion method.Results: Out of 100 sputum samples, 44% positive bacterial growths, majority isolates were Klebsiella spp and Staphylococcus aureus. Overall, the pathogens were mostly sensitive to meropenem followed by colistin, piperacilin/tazobactam respectively.Conclusion: Bacterial co-infection is common in hospitalized patients with SARS-CoV-2.
2019冠状病毒病(COVID-19)大流行是由严重急性呼吸综合征冠状病毒2引起的。病毒和细菌呼吸道病原体的共同进化创造了一种环境,在这种环境中,病毒感染允许并发或继发性细菌共感染。目的:分离新冠肺炎患者不同呼吸道病原菌,评价其抗生素敏感性。方法:在尼泊尔第二波COVID-19期间,在尼泊尔Kohalpur尼泊尔gunj医学院进行了基于医院的描述性横断面研究,时间为2078年第2 Jestha至第5 Shrawan(2021年5月16日至7月20日)。将痰液接种于血琼脂(Blood Agar, BA)和麦康基琼脂(MacConkey Agar, MA)等不同培养板上,37℃孵育。经过过夜生长和革兰氏染色,观察到革兰氏阳性和阴性菌的不同。采用Kirby-Bauer纸片扩散法进行抗生素敏感性试验。结果:100份痰液标本中细菌生长阳性率为44%,以克雷伯氏菌和金黄色葡萄球菌为主。总体而言,病原菌对美罗培南最敏感,其次是粘菌素、哌拉西林/他唑巴坦。结论:SARS-CoV-2住院患者细菌合并感染较为常见。
{"title":"Evaluation of Bacterial Co-infections of the Respiratory Tract in COVID-19 Patients","authors":"K. Gurung, P. Pant, Sandeep Pokhrel, Dhan Raj Neupane, Samjhana Gurung","doi":"10.3126/jngmc.v19i2.42851","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42851","url":null,"abstract":"Introduction: The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2. The co-evolution of viral and bacterial respiratory pathogens has created an environment in which a viral infection allows concurrent or secondary bacterial co-infections.\u0000Aims: This study was carried out to isolate the different respiratory bacterial pathogens from COVID patients and evaluate their antibiotic sensitivity pattern.\u0000Methods: Hospital based descriptive cross sectional study was conducted over a period of between 2nd Jestha to 5th Shrawan 2078 (16th May to 20th July 2021) in Nepalgunj Medical college, Kohalpur during the second wave of COVID-19 in Nepal. The sputum was inoculated onto different culture plates such as Blood Agar (BA) and MacConkey Agar (MA) and incubated at 37 oC. After overnight growth and in Gram staining, different Gram’s positive and negative bacteria were observed. Antibiotic sensitivity test was performed by Kirby-Bauer Disk Diffusion method.\u0000Results: Out of 100 sputum samples, 44% positive bacterial growths, majority isolates were Klebsiella spp and Staphylococcus aureus. Overall, the pathogens were mostly sensitive to meropenem followed by colistin, piperacilin/tazobactam respectively.\u0000Conclusion: Bacterial co-infection is common in hospitalized patients with SARS-CoV-2.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125609164","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}
引用次数: 1
Distal Humeral Diaphyseal Open Fracture in a Child with Bone Loss 儿童肱骨远端骨干开放性骨折伴骨质丢失1例
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.43005
S. Shrestha, D. Shrestha
Distal diaphyseal humerus fracture is less common than supracondylar humeral fracture and its open fracture is even less. This is a case report of open distal humeral diaphyseal fracture on the left arm with bone loss in 10 years old male who sustained the injury from fall, diagnosed as Grade III open unstable distal diaphyseal shaft fracture of left humerus with bone loss without neurovascular deficit. We performed Open Reduction /Internal Fixation (OR/IF) and free bone fragment was flipped and fixed to the bone fragments and maximum possible contact was made and fixed with an external fixator. Range of motion was advised as early as possible. At final follow up the result was excellent as per Flynn's criteria. OR/IF (Open Reduction /Internal Fixation) of this fracture with posterior approach and flipping the bone to get more contact seems good and safe procedure. Further, external fixation provides reasonable fixation in these cases.
肱骨骨干远端骨折较肱骨髁上骨折少见,其开放性骨折更少。本文报告一例10岁男性,因跌倒受伤,左臂开放性肱骨远端骨干骨折伴骨丢失,诊断为左肱骨开放性不稳定远端骨干骨折伴骨丢失,无神经血管缺损。我们进行了切开复位/内固定(OR/IF),将游离骨碎片翻转并固定在骨碎片上,并使用外固定架进行最大可能的接触和固定。运动范围应尽早得到建议。根据弗林的标准,最后的随访结果非常好。OR/IF(切开复位/内固定)采用后路入路并翻转骨头以获得更多接触似乎是一种良好且安全的手术。此外,在这些病例中,外固定架提供了合理的固定。
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引用次数: 0
Unusual Case of Foreign Body Ingestion in a Child: A Case Report 儿童异常异物误食1例
Pub Date : 2021-12-31 DOI: 10.3126/jngmc.v19i2.43006
S. Nag
Foreign body ingestion is a common problem in pediatric age group patients throughout the world. Radiographic findings revealed multiple foreign bodies throughout abdomen. Foreign objects attach frequently at the esophageal anatomic narrowing. They must be taken out immediately because they can cause an obstruction, mucosal erosion or perforation. Endoscopy is the criterion standard for removal of foreign bodies from the esophagus. Here, we report an interesting case of a multiple stones ingested by a female child. The child presented with complaints of distension of abdomen, vomiting and pain all over abdomen. The foreign bodies were found as hard black stones after removing them through anal route.
异物摄入是世界各地儿童年龄组患者的常见问题。x线检查显示腹部多处异物。异物常附着于食管解剖狭窄处。必须立即取出,因为它们会引起阻塞、粘膜腐蚀或穿孔。内镜检查是清除食管异物的标准。在这里,我们报告一个有趣的情况下,多颗结石摄入由一个女孩的孩子。儿童主诉腹部膨胀、呕吐及全身疼痛。经肛门取出后,发现异物为坚硬的黑色结石。
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引用次数: 0
期刊
Journal of Nepalgunj Medical College
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