Journal of College of Medical Sciences-Nepal <p>Official journal of the College of Medical Sciences, Bharatpur, Nepal. Full text articles available. Also available at <a title="JCMS-Nepal" href="" target="_blank" rel="noopener"></a>.</p> <p>Journal of College of Medical Sciences-Nepal is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> International Society of Medical Education Pvt. Ltd. en-US Journal of College of Medical Sciences-Nepal 2091-0657 Thoracoscopic Surgery for Posterior Mediastinal Mass: Our Initial Experience <p><strong>Background:</strong> Thoracoscopic surgery has been increasingly used for a variety of indications. Posterior mediastinal tumors form an important component of a thoracic surgeon’s workload. This report represents a summary of our initial experience in thoracoscopic management of such tumors.</p> <p><strong>Methods:</strong> We retrospectively reviewed the clinical and operative data from records over the study period. We also describe our usual perioperative management and surgical techniques.</p> <p><strong>Results:</strong> A total of 11 patients, 8 being females, were operated during the period of 30 months. Seven were incidental findings, and chest pain was the commonest presentation in symptomatic patients. The mean age of the patients was 38.7 years; mean tumor diameter was 4.4 cm; eight had benign schwannoma, and no patient had a malignant tumor. Mean operative duration was 175.5 min; there were no conversions and no transfusion was required. Mean length of stay in the hospital was 5.6 days. There were no perioperative deaths or major complications. Three minor complications were recorded. Follow-up (4 to 18 months) was uneventful.</p> <p><strong>Conclusions:</strong> Thoracoscopic management of posterior mediastinal tumors is feasible and safe.</p> Ranjan Sapkota Prakash Sayami ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 75 79 10.3126/jcmsn.v15i2.24174 Effect of 2% Lignocaine Solution in Pain During Removal of Nasal Pack <p><strong>Background:</strong> Nasal packing is commonly done after septal surgeries. Nonabsorbable nasal pack is used to minimize bleeding from surgery site, support the mucoperichondrial flaps, and minimize the risk of formation of septal hematomas and adhesions. However, these materials cause pain and discomfort in-situ as well as during removal. This study was done to evaluate the effect of 2% lignocaine rehydration of nasal pack on pain during pack removal.</p> <p><strong>Methods:</strong> This prospective study was conducted on 60 patients who had undergone septoplasty. The patients were divided into 2 groups: Lignocaine and Normal saline group, with 30 patients each. In the Lignocaine group, 2.5 ml of 2% of lignocaine was diluted with 2.5 ml of distilled water and was injected into the nasal pack; and in Normal saline group, 5 ml of normal saline was injected into the nasal pack. Nothing was injected to the left nostril, which acted as a control, in both groups. All patients were asked severity of pain during removal of nasal packing by VAS.</p> <p><strong>Results:</strong> In lignocaine group, mean pain score was 3.73 ± 1.63 on lignocaine side and 6.23 ± 1.69 on control side (U=109.5, p&lt;0.001). In Normal saline group, it was 6.5 ± 1.7 on normal saline side and 6.23 ± 1.96 on control side (U=425.5, p=0.711). On comparing VAS between lignocaine and normal saline group, pain was significantly lower in the lignocaine group (U=112.5, p&lt;0.001)</p> <p><strong>Conclusion:</strong> Rehydrating nasal pack with 2% topical lignocaine is a useful method to reduce pain during nasal pack removal.</p> Ashish Dhakal Bikash Lal Shrestha Monika Pokharel ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 80 83 10.3126/jcmsn.v15i2.22629 Prevalence of Hypovitaminosis D in Patients Visiting a Tertiary Care Center in Chitwan, Nepal <p><strong>Background:</strong> As documented by a large body of evidences, Hypovitaminosis D prevails both in the general and the hospitalized populations. We conducted this study to determine the prevalence of hypovitaminosis D amongst the patients visiting a tertiary care hospital and compare the rate gender-wise, across different categories of socio-demographic variables.</p> <p><strong>Methods</strong>: It was a cross-sectional study (retrospective chart review) based on the hospital registry of patients at College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal. From the registry, we retrieved the socio-demographic variables (age, gender, ethnicity and season) along with serum vitamin D (25-hydroxy-cholecalciferol) concentrations of the study subjects from January 2015 to August 2018, for our analysis. Hypovitaminosis D was defined as serum vitamin D &lt;30 ng/mL (insufficiency: 20-30ng/mL and deficiency: &lt;20 ng/mL).</p> <p><strong>Results</strong>: The overall prevalence of hypovitaminosis D was 70.7% (insufficiency: 35.9% and deficiency: 34.8%), 72.4% (females), 64.2% (males), 76.3% (first age-quartile), 74.5% (miscellaneous ethnic group), and 73.9% (Spring). Females had higher prevalence rates of hypovitaminosis D (and lower median serum 25-hydroxy-cholecalciferol lev-els) as compared to males, in overall participants, and those under each category of age, ethnicity and season (except Winter).</p> <p><strong>Conclusions</strong>: The greater prevalence of hypovitaminosis D in the females than the males in the face of high rate in the overall hospital-visiting clearly calls for necessary strategies in the form of further studies and judicious prescription of supplementary vitamin D in the target population.</p> Kushal Bhattarai Nilu Manandhar Sarita Dhakal ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 84 92 10.3126/jcmsn.v15i2.23483 Bacteriological Profile of Neonatal Sepsis in a Neonatal Intensive Care Unit of a Tertiary Care Hospital of Eastern Nepal <p><strong>Background:</strong> Neonatal sepsis is a common and serious problem of neonates who are admitted for intensive care. It is a leading cause of neonatal morbidity and mortality worldwide. The objective of the study was to detect the common causative microorganisms of neonatal sepsis and their antibiotic susceptibility patterns in NICU of Nobel Medical College Teaching Hospital (NMCTH).</p> <p><strong>Methods</strong>: This was a cross-sectional study conducted in a 17- bedded teaching and referral NICU of NMCTH from March to August, 2018. All neonates of clinical sepsis were enrolled in the study, blood cultures taken and were followed up till final outcome, which was discharge or death, irrespective of culture report. Descriptive statistics including percentages and frequencies was used.complications.</p> <p><strong>Results:</strong> Among the 55 neonates with diagnosis of clinical sepsis, 13(23.6%) had shown bacteria in the culture. The predominant organisms were Staphylococcus aureus and Klebsiella pneumoniae and most of them were resistant to Ampicillin and Amikacin.</p> <p><strong>Conclusions:</strong> The culture positivity rate among the neonates with clinical sepsis in the study was 23.6%. Pathogens isolated were resistant to the first line drugs for management of neonatal sepsis. Hence, the need for a review of first line drug for empirical treatment of neonatal sepsis.</p> Sunil Kumar Yadav Arun Giri ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 93 97 10.3126/jcmsn.v15i2.20747 Evaluation of Results of Ilizarov Fixator and Methodology in Tibial Non- Union <p><strong>Background:</strong> Treatment of non-union of tibial diaphyseal fractures has always posed a formidable challenge to surgeons. Persistant infection, deformity, bone loss, stiffness of joints and disability complicate the problem further. Ilizarov methodology tackles all the above problems simultaneously and offers a solution for non-union. Progressive new bone formation and increased vascularity following corticotomy and bone transport helps in filling bone gaps and promoting fracture union. Stability of the fixation allows early weight bearing, ambulation and joint mobilization. To evaluate the results of Ilizarov fixator in treating tibial non-union.</p> <p><strong>Methods</strong>: This retrospective hospital study was conducted at Ramakrishna Mission Seva Pratishthan, Kolkata, India from August 2009 to February 2012. Forty two patients treated at this hospital between August 1994 and August 2011 with a minimum of 12 months follow up were included. The results were analysed on the outcome of bone and functional score using the Association for the Study and Applica-tion of the Method of Ilizarov (ASAMI) scoring system.</p> <p><strong>Results</strong>: Of the 42 patients in this study, there were 28 (66.7%) excellent, 6 (14.3%) good, 5 (11.9%) fair and 3(7.1%) poor bone results and 17(40.5%) excellent, 20(47.6%) good, 2(4.8%) fair and 3(7.1%) poor functional results.</p> <p><strong> Conclusions</strong>: Treatment of tibial non-unions with Ilizarov fixator is effective but not without considerable amount of complications and morbidity associated with it. The functional outcome was largely multifactorial and dependent on the final joint function, soft tissue condition and ability of the patient to return to activity.</p> Jayabrata Ghosh Prashanta Kumar Pujari ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 98 102 10.3126/jcmsn.v15i2.19479 Correlation between Radiological Parameters and Functional Outcome of Healed Unstable Fracture Distal Radius after External Fixation <p><strong>Background</strong>: Wrist fractures represent about one-sixth of all fractures seen in emergency department. The goal of treating such fractures is no longer only fracture union, but also the restoration of normal anatomy with early functional recovery, as well as full and painless motion of the wrist. In this prospective study we intend to evaluate the correlation between functional outcome and radiological parameters of the unstable fracture of the distal radius when treated with external fixator.</p> <p><strong>Methods</strong>: A hospital based, observational study was conducted at department of Orthopedics, College of Medical Sciences Teaching Hospital, Bharat-pur, Chitwan, during the period of January 2011 to November 2013, 54 patients, 33 male and 21 female, with unstable fracture of the distal end of radius were treated with external fixator and followed for a period of 18 weeks.</p> <p><strong>Results</strong>: The clinical and radiological outcome were evaluated on the basis of Modification, by Sar-miento et al., of the Demerit Point system of Gartland and Werley and Sarmiento et al’s modification of Lid-strom’s scoring system respectively at the end of 18 weeks. The clinical result was excellent in 25 cases, good in 19 cases and fair in eight cases. There were 8 (15.4%) excellent, 25 (48.1%) good, 15 (28.8%) fair and 4 (7.7%) poor cases according to radiological scoring.</p> <p><strong>Conclusions</strong>: In this study we found no correla-tion between clinical outcome and radiological parameters following external fixation in distal radius fractures.</p> Robin Shrestha Hemant Gupta Manoj Kandel ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 103 106 10.3126/jcmsn.v15i2.21127 Assessment of Malnutrition as a Risk Factor for Acute Lower Respiratory Tract Infection in Children under 5 yr Age at a Tertiary Hospital <p class="Allmntstyckeformat"><strong>Background</strong>: Malnutrition among young children is becoming a major public health concern in low income countries like Nepal where under nutrition remains one of the primary causes of ill health. Acute lower respiratory tract infection (ALRTI) and malnutrition in children are associated with morbidity and mortality in developing countries.Objective of this study was to assess ALRTI as a risk factor for malnutrition in children at Kathmandu Medical College Teaching Hospital.</p> <p class="Allmntstyckeformat"><strong>Methods</strong>: This was a cross-sectional study con-ducted at Kathmandu Medical College Teaching Hospital over 5 months duration (August - December 2017). Under 5 yrs children diagnosed as ALRTI were taken and healthy children from same age group attending the immunization clinic were the controls. Anthropometric measurements were measured and stunting and wasting were described according to the WHO classification of malnutrition. Data were analyzed using SPSS version 18. Statistical analyses were done in the form of frequency, mean and cross tabulation. Chi-Square test was used to assess the association of ALRTI with malnutrition. P value &lt;0.05 was considered to be sig-nificant.</p> <p class="Allmntstyckeformat"><strong>Results</strong>: A total of 200 children were included in this study. Children with ALRTI (n = 90) and con-trols (n =110) were analyzed. Male participants were observed more in both groups (60% and 68%). Wasting and stunting were observed more in ALRTI group than in control groups.</p> <p class="Allmntstyckeformat"><strong>Conclusions</strong>: This study showed there was a relation between ALRTI and malnutrition in children. So, this study has identified malnutrition as one of the major risk factor for ALRTI in under 5 yrs children.</p> Sunil Raja Manandhar Petter Thorell Ida Kallur Sunil Kumar Joshi ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 107 111 10.3126/jcmsn.v15i2.21840 Awareness among the Dental students and Dental Interns of Kantipur Dental College and Hospital regarding Antibiotics Prophylaxis for Infective Endocarditis <p><strong>Background</strong>: Infective Endocarditis is relatively a rare disease and is believed to be caused by the vegetative growth on the previously damaged or congenitally malformed cardiac valves or endocardium. Several factors determines that the dentist practicing prophylaxis measures, the foremost important one is the knowledge which is taught to them during dental school, which is the main reason to conduct this study to test the awareness among the dental students of Kantipur Dental College and Hospital, Kathmandu regarding the prophylaxis guideline awareness.</p> <p><strong>Methods</strong>: BDS Third, Fourth, Fifth year students and Dental Interns of Kantipur Dental College and Hospital were asked to fill the self-answered questionnaires. The questions were divided into two parts each part containing ten questions each. The first part was to access the knowledge of participants regarding the cardiac conditions that require antibiotics prophylaxis, the second part was to access the knowledge of participants regarding the dental procedures that requires antibiotics prophylaxis.</p> <p><strong>Results</strong>: Thirty two percentage of our participants responded that forceps extraction does not require antibiotics prophylaxis which is not true as per AHA guideline, so the participants should be taught regarding the risk of forceps extraction leading to infective endocarditis if the prophylaxis is not administered. We postulated that majority of the Dental Students and Interns have heard about AHA 2007 guideline and will follow it when necessary.</p> <p><strong>Conclusions</strong>: The participants who are the Dental Students and Dental Interns in a Dental School at Kathmandu, Nepal will be practicing Dentistry in near future, the knowledge they acquire during their learning period will help them to prevent the Infective endocarditis among the risk population whom they will be treating in near future. Measures should be taken to prevent the incidence of Infective Endocarditis with dental origin.</p> Prenit Kumar Pokharel Shrijana Chapagain ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 112 118 10.3126/jcmsn.v15i2.22162 Impact and Perception of Social Networking Sites on Academic Performance of Medical Students <p><strong>Background: </strong>A social networking site is an online platform that allows users to create a public profile and interact with other users on the website. The emergence of Social Networking Sites has broadened the base of contact, interaction and communication among people living round the globe via internet. Millions of students are logging in to these social networking sites, everyday. That’s why many students have been blaming various social networking sites for their steady decrease in grade point averages and has affected their study time, poor grammar and wrong spellings when socializing on social media as well as diverting their attention from their studies. The objective of this research is to find the impact and perception of social networking sites on academic performance of medical students.</p> <p><strong>Methods: </strong>A descriptive cross-sectional study design conducted among 230 Medical students of MBBS, BPH, Pharmacy and BN Nursing’s students. A well-structured questionnaire was prepared and which were distributed among students using probability sampling technique (random number table).</p> <p><strong>Results: </strong>The response of 230 students was collected by using well structure questionnaire. The mean±SD of students age was 21.87±2.16 years. Majority of the students were in the age group 20-25 years. Majority of them were female by gender and Hindu by religion. They most commonly used social networking site was face book/messenger (48.7%) followed by YouTube (41.3%). The main aim of using these sites is to update with their family, friends and for entertainment. Nearly 60% students told that there are negative effects of using social networking sites. And only 15.6% students used these sites only for academic purpose.</p> <p><strong>Conclusions: </strong>This study revealed that majority of the students used mobile phone as a device and Wi-Fi in their place of residence. The overall perception of students towards social networking sites is positive. Excessive use of these sites decreases their academic performance which conclude that there is Negative relationship between the use of social networking sites and academic performance which in turn negatively affect their academic results.</p> Hari Prasad Upadhyay Prativa Sedain ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 119 124 10.3126/jcmsn.v15i2.23838 Assessment of Role of Human Papilloma Virus in Patients with Oral Squamous Cell Carcinoma <p><strong>Background</strong>: Head and neck malignancies include malignancies instigating in the oral cavity, the orophar-ynx, the hypopharynx and the larynx. We planned the present study to assess the role of human papilloma virus (HPV) in patients with oral squamous cell carcinoma (OSCC).</p> <p><strong>Methods</strong>: The present study included assessment of role of human papilloma virus in patients with oral squamous cell carcinoma. A total of 50 histopathologic proven cases of well differentiated OSCC were included in the present study. A total of 50 healthy oral mucosal tissues (controls) were also included in the present study. The controls were obtained while surgical removing the impacted teeth. DNA was obtained from the tissue sections and underwent Polymerization chain reaction for identification of HPV 16/18. All the results were summarized in Microsoft excel sheet and were analyzed by SPSS software.</p> <p><strong>Results</strong>: HPV was absent in all the cases of control group, whereas among the OSCC group, the HPV was detected in 46 percent of the cases. In the remaining 54 per-cent of the cases of the OSCC group, HPV was absent. Significant results were obtained while comparing the presence of HPV in between the OSCC group and the control group.</p> <p><strong>Conclusions</strong>: HPV was present in sig-nificant number of OSCC cases. Therefore; HPV might play a contributing role in the etio-pathogenesis of OSCC.</p> Krishan Kumar Tyagi Megha Pradhan Rajbir Kaur Grewal Prabesh Sherchan KSA Pasha ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 125 127 10.3126/jcmsn.v15i2.22707 Prevalence of Occupational Health Consequences During Sugarcane Harvesting Among Harvesters of Morang District <p><strong>Background:</strong> Sugarcane harvesting is widely practiced in Nepal. While harvesting most of the farmers are affected regularly with small bruises, cuts, wounds, lacerations and sometimes major cut injury or even an amputation of fingers. This study aims to find the prevalence of occupational health hazards among sugarcane harvesters during the sugarcane harvesting time.</p> <p><strong>Methods:</strong> The descriptive cross-sectional study was conducted at Bhaudaha VDC which is now incorporated in Katahari rural municipality, Morang. Sample size was 96 during the two weeks of study from December 2014. Convenient sampling method was used. Ethical approval was cleared from the Institutional Review Committee.</p> <p><strong>Results:</strong>&nbsp; Most of the sugarcane harvesters were male comprising 83.3 percent. Mean age among them was 31.71. Eighty six percent of harvester had nasal congestion, 67.7% had minor cuts whereas approximately 4.2% of them had major cuts. Shoulder joint, wrist joint, neck joint and low back pains were the mostly encountered musculoskeletal pain.</p> <p><strong>Conclusions:</strong> Occupational hazards among sugarcane harvesters were mostly related to the musculoskeletal problems, respiratory problems, minor cuts, major cuts and eye related problems.</p> Bijay Thapa Archana Sharma ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 128 131 10.3126/jcmsn.v15i2.23813 Knowledge on Genitourinary Fistula among Nurses in a Tertiary Hos-pital of Eastern Nepal <p><strong>Background</strong>: Genitourinary fistula, occurs most commonly due to preventable obstetric causes in developing countries. Women with obstetric fistula are at risk of infection, neglected from family and bear psychological distress due to stigma and social isolation. They require supportive care through multidisciplinary approach. Nurses occupying the larger workforce among the health-personnel are the frontier to care them throughout their life. Their knowledge on obstetric fistula will help to manage patients effectively. The aim of this research was to assess the knowledge on genitourinary fistula among nurses working in maternity wards of B. P. Koirala Institute of Health Sciences, Nepal.</p> <p><strong>Methods</strong>: AHospital based cross-sectional study was conducted from May 2018 to January 2019 using self-administered questionnaire among nurses working in antenatal, intranatal, postnatal and gynecology ward of B. P. Koirala Institute of Health Sciences, Nepal. Forty nurses were enrolled after having informed consent. Collected data were entered in Microsoft excel and analysed using SPSS.</p> <p><strong>Results</strong>: Only 42.5 % nurses had adequate knowledge on genitourinary fistula. Majority of them (90%) had correct response on definition of genitourinary fistula. Almost 83% correctly responded vesicovaginal fistula is the most common type. About 37.5% stated obstetric causes are main causes of genitourinary fistula in developing countries. Only 20% correctly responded the possible sign and symptoms of genitourinary fistula. Adequate knowledge on prevention of obstetric fistula (35%), surgical repair (20%), pre-operative management (12.5%) and discharge advice (20%) was found.</p> <p><strong>Conclusions</strong>: This study concludes that majority of nurses working at antenatal, intranatal, postnatal and gynecology wards of B. P. Koirala Institute of Health Sciences, Nepal had moderate knowledge on genitourinary fistula.</p> Heera KC Nirmala Pokharel Mangala Shrestha Gayatri Rai Surya Bahadur Parajuli ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 132 138 10.3126/jcmsn.v15i2.24113 Morphology of Dorsal Venous Arch of Hand: A Cadaveric Study <p><strong>Background</strong>: Venous network of hand is superficially placed and is easy to trace for clinical purposes. Ce-phalic vein on lateral aspect and basilic vein on medial aspect of the hand are clinically important for inva-sive and surgical procedures. Thus the study of cephalic and basilic veins at dorsal venous arch of hand was dissected to observe for length of dorsal venous arch and the diameter and thickness of cephalic and basilic veins.</p> <p><strong>Methods</strong>: This is a cross-sectional observational study conducted in 50 hands of cadavers (36 hands of male cadavers, 14 hands of female cadavers) in Department of Anatomy, Kathmandu Medical College Teaching Hospital, Duwakot. Cadavers were performed to measure the length of dorsal venous arch, diame-ter and thickness of cephalic and basilic vein on dorsum of hands.</p> <p><strong>Results</strong>: The mean±s.d. length of dorsal venous arch in male cadaver (19.03±2.84 cm.) was significantly greater than in female (16.51±1.36 cm.).There was no significant difference in length of dorsal venous arch on right (18.22 ±2.47 cm.) and left side (18.42±3.05 cm.) in either sex. The mean±s.d thickness of basilic vein (0.10±0.01mm) in either sex was significantly greater than that of cephalic vein (0.09±0.01mm).</p> <p><strong>Conclusions</strong>: The length of the dorsal ve-nous arch in male cadavers was found significantly greater than in female cadavers. The diameters based on external and internal circumference of basilic veins was found to be more than diameter of cephalic veins in both male and female cadavers. The thickness of basilic vein was found to be more (0.10±0.01mm) than that of cephalic vein (0.09±0.01mm) in cadaver of both sexes.</p> Nripendra Tiwari Deepesh Budhathoki Iju Shrestha Ram Timsina Santosh Kumar Shah Banshi Krishna Malla ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 139 143 10.3126/jcmsn.v15i2.23294 Comparision of the Spirometric Measurements of Multi-National Under-graduate Medical Students from a Medical College of Central Nepal <p class="Default"><strong><span style="font-size: 11.0pt;">Background: </span></strong><span style="font-size: 11.0pt;">The application of pulmonary function testing is increasing in many areas of clinical medicine, including assessment of airflow limitation, diagnosis of airflow obstruction and lung restriction, evaluation of pulmonary impairment, preoperative assessment as well as public health screening. In this study, attempt has been made to evaluate Pulmonary Function Test (PFT) of healthy Nepalese young adults and compare their values with healthy Indian and Sri Lankan counterparts. Further, it tries to shed light on the correlation of these data with anthropometric parameters. </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Methods: </span></strong><span style="font-size: 11.0pt;">A total of 133 pre-clinical medical students of Manipal College of Medical Sciences were included in the study. PFT was done using a computerized automatic spirometer. </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Results: </span></strong><span style="font-size: 11.0pt;">All the pulmonary parameters showed significant gender differences. All mean value of PFT parameters were higher in males. The comparisons of different parameters of PFT according to gender between three countries namely Nepal, India and Sri Lanka showed that Nepalese and Indian females had a higher FEV</span><span style="font-size: 7.0pt;">1 </span><span style="font-size: 11.0pt;">and FVC values than Sri Lankan females (p&lt;0.05). Sri Lankan females had lower FEV</span><span style="font-size: 7.0pt;">1 </span><span style="font-size: 11.0pt;">and FVC as compared to Nepalese and Indian females (p&lt;0.05). However, no correlation was observed between PFTs and BMI. </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Conclusions: </span></strong><span style="font-size: 11.0pt;">Although some significant differences on PFT parameters were observed in Sri Lankan data when compared with Nepalese and Indian data, no significant difference was noticed between Nepalese and Indian values of PFT. Therefore Indian prediction equation for PFT can be used for Nepal but only after further study with a larger sample size.</span></p> Sameer Timilsina Sirisa Karki Bhuwan Baskota ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 144 149 10.3126/jcmsn.v15i2.21314 Large Enchondroma of Metacarpal Bone with Pathological Fracture Treated with Marginal Resection and Reconstruction with Iliac Crest Graft: A Rare Case Report <p>Enchondroma is the benign bone tumor commonly found in phalanx and metacarpal shaft. The most common method of treatment is curettage with or without filling cavity with bone graft with recurrence rate up to 13%. We present a large enchondroma of fourth metacarpal right hand with cortical breach treated with marginal excision and reconstruction of segmental defect with tricortical iliac crest bone graft with excellent functional and cosmetic result. We opted to report this case because of the large size of the tumor and successful reconstruction of metacarpal with simple technique of autograft.</p> Suresh Pandey ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 150 152 10.3126/jcmsn.v15i2.23275 Spontaneous Retropharyngeal Haematoma: Case Report and Literature Overview <p>Spontaneous retropharyngeal hematoma is a rare and difficult case to diagnose early. Very few cases have been reported in the literature. We report a rare case of spontaneous retropharyngeal hema-toma presenting with acute onset of neck pain, neck motion limitation and dysphagia. The diagnosis was established by Magnetic Resonance Imaging. The hematoma was drained and the patient condition improved. It is important to be aware of this unusual condition with its distinct presentation. Most cases will resolve with conservative management. Surgical intervention is needed if medical management fails.</p> Apar Pokharel Prabhat Basnet Naganawalachulu Jayaprakash Mayya Damodar Kandel ##submission.copyrightStatement## 2019-06-30 2019-06-30 15 2 153 155 10.3126/jcmsn.v15i2.24001