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 Clinical Profile of Severe Cutaneous Drug Eruptions in a Tertiary Care Hospital <p><strong>Background: </strong>An adverse cutaneous reaction caused by a drug is any undesirable change in the structure or function of the skin, its appendages or mucous membranes and it encompass all adverse events related to drug eruption, regardless of the etiology.&nbsp;</p> <p><strong>Methods: </strong>This is a retrospective descriptive cross-sectional study done fom April 2017 to March 2019 at dermatology department of Kathmandu Medical College Teaching Hospital. Sample size was calculated as 42 with prevalance of severe cutaneous drug eruption as 3%. After the medication history was taken, all suspected causative drugs were discontinued. For the initial 5 to 7 days, all patients were treated with intravenous corticosteroids and oral antihistamines. Follow up after one week, 2 weeks and one month were suggested for assessment of outcomes.</p> <p><strong>Results: </strong>Out of 42 patients, 22 (52.38%) were females and 20 (47.62%) males. Most were in age groups 16-39 &amp; 46-60 counting to 14 (33.33%) in each group. Acute morbilliform eruption was the most common presentation 20 (47.6%) followed by Steven Johnson Syndrome-Toxic Epidermal Necrolysis in 16 (38.1%). The most common offending drug group in this study was antileptics 9 (21.43%), followed by NSAIDs 8 (19.05%), antibiotics 7 (16.67%), allopurinol 4(9.52%%). Patients were discharged after 7 days with tapering dose of oral prednisolone upto 6 weeks for all patients. However, three patients died due to Toxic Epidermal Necrolysis along with comorbid conditions like intracerebral hematoma, COPD with pneumonia.</p> <p><strong>Conclusion</strong><strong>: </strong>Adverse cutaneous drug reactions should be recognized early for timely intervention. Previously sensitized patients should be made aware about fatal outcomes, symptoms, cross reactivites as well as over the counter preparations.</p> Rupak Bishwokarma Ghimire Sabina Bhattarai Govinda Pokharel Eliz Aryal Prashanna Raj Shrestha ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 156 159 10.3126/jcmsn.v15i3.24306 Bacteriological Profile of Burn Patients and Antimicrobial Susceptibility Pattern of their Wound Isolates at Nepal Cleft and Burn Center <p><strong>Background: </strong>Burn infections are the major causes of morbidity and mortality in burn patients. The infectious agent could be both Gram positive and Gram negative bacteria. The aim of this research was to study the bacteriological profile of burn patients and anti-microbial susceptibility pattern of their wound isolates.</p> <p>&nbsp;<strong>Methods: </strong>This cross-sectional study was conducted in Kirtipur Hospital, Nepal from January 1<sup>st</sup> to March 31<sup>st</sup> 2019. A total of 109 burn patients were included and their wound swabs were collected at the time of admission. All isolates were identified by standardized microbiological procedures. Anti-microbial susceptibility tests were performed by Kirby Bauer disc diffusion method.</p> <p><strong>Results: </strong>Of 109 burn wound samples, 56 (59%) yielded culture growth and the Gram negative isolates were more common than Gram positives (77% vs. 23%). The most common organism isolated was Klebsiella spp. (25%) followed by Acinetobacter spp. (21%) and Staphylococcus aureus (18%). Most burn wound isolates were of resistant strain. Particularly, highly resistant strain of Acinetobacter spp. were isolated, most of which were sensitive to Tigecycline, Polymyxin B and Colistin only.</p> <p><strong>Conclusion : </strong>Gram negative isolates were common in burn wound isolates and the antibiotic susceptibility pattern was different for different organisms. The use of antimicrobials should be judicious to further not escalate the problem of antimicrobial resistance in the healthcare settings.</p> <p>&nbsp;</p> Apar Lamichhane Kiran Kishor Nakarmi Peeyush Dahal Surendra Jung Basnet Pashupati Babu Pokharel Suraj Bhattarai Shankar Man Rai ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 160 166 10.3126/jcmsn.v15i3.24363 Improvement of Vision after Resection of Pituitary Tumor <p><strong>Background</strong>: Pituitary adenomas are the most common type of pituitary disor­der. Compression of anterior visual apparatus leads to impairment of vision. Visual impairment depends on individual relation between tumor and visual apparatus, duration of compression, timing of operative intervention amongst others. Surgical excision is treatment of choice for tumors causing impairment of vision. Predicting outcome after surgical decompression thus helps both patient and surgeon to make realistic expectations and avoid unnecessary complication from overzealous aggressiveness. Predictors of visual outcome are not well established. This study aims to identify factors that predict visual improvement after resection of pituitary tumor.</p> <p><strong>Methods</strong>: A prospective study was planned to study factors associated with visual outcome. Visual acuity was measured by using snellen’s chart and categorized using WHO vision impairment scale for distant vision. Visual field was measured either by Humphrey or Goldmann perimetry. Visual evaluation was done before surgery and after 3 months of surgery. Data was analyzed using SPSS version 23.</p> <p><strong>Results</strong>: Twenty-eight eyes of fourteen patients were evaluated. Mean age at presentation was 38 years. Mean duration of impairment of vision at presentation was 13 months. Nonfunctioning pituitary adenoma was the most common pathology. Mean size of tumor was 3.07 cm. Visual acuity improvement was seen in 17(61%) and visual field improvement in 16(57%) of patients. Visual outcome was significantly affected by preoperative visual status and size of tumor. Extent of resection, duration of symptom were not associated with visual outcome.</p> <p><strong>Conclusion</strong>: Excision of Pituitary tumor from sella provides enough decompression to anterior visual apparatus resulting in improvement of visual acuity and field of vision. Preoperative visual status and size of tumor can predict postoperative visual outcome.</p> Hari Poudel Bikesh Khambu Rajendra Shrestha Nilam Khadka Rajeev Jha Prakash Bista ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 167 170 10.3126/jcmsn.v15i3.24895 Epidemiological Outbreak Investigation of Chickenpox in Baidauli VDC, Nawalparasi, Nepal <p><strong>Background:</strong> On 2015, a cluster of chickenpox like symptoms was reported in Baidauli VDC of Nawalparasi, Nepal. This study aims to report the outbreak investigation and guide preventive and control measures.</p> <p><strong>Methods:</strong> This investigation was conducted in Baidauli VDC of Nawalparasi, Nepal where a large number of cases with infectious rashes with fever was reported. Data were collected using a semi-structured questionnaire comprising of socio-demographic characteristics and clinical features. A detailed clinical examination of the cases was also performed. The outbreak was described by time, place and person and the epidemiological curve drawn.</p> <p><strong>Results:</strong> A total of 55 cases from 27 households were affected by chickenpox. The outbreak continued for 45 days. The number of cases peaked (n=25) one month after detection of the primary case. The last case was reported after 15 days of the peak. The commonest age group affected was 5 to 15 years with a mean of 11.3 years (SD 8.9). The mean duration of rashes was 7.2 days (SD 1.7) which ranged from 3 days to 12 days. All the cases had rashes on head/face, trunk, arm and legs, and some had rashes inside the mouth (n=8) and palm (n=5).&nbsp; Almost 95% (n=52) cases experienced fever.</p> <p><strong>Conclusions:</strong> This study concluded that there was an outbreak of chickenpox. The signs and symptoms of the disease were due to chicken pox infection. Immediate preventive and control measures were recommended to halt the spread of the disease. Health education and awarness regarding the preventive measures of disease should be promoted.</p> Ram Chandra Poudel Sabika Munikar Biswanath Acharya Gambhir Shrestha Kanchan Thapa ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 171 174 10.3126/jcmsn.v15i3.24642 Prevalence of Intestinal Parasites among Patients attending a Tertiary Care Centre in Central Nepal <p><strong>Background:</strong> Intestinal parasitic infections are important public health problem and are globally endemic. These parasites are responsible for the major share of morbidity and mortality in those communities where there is overcrowding, poor environmental sanitation and personal hygienic practices. Intestinal parasitic infection is highly prevalent among the general population in Nepal. This study was aimed to evaluate the burden of the intestinal parasitic infections and the pattern of distributions among patients attending in a tertiary care setting in Bharatpur, Nepal, over a period of one year (August 2017 to July 2018).</p> <p><strong>Methods: </strong>Stool samples of patients received in the Microbiology laboratory, COMS that were subjected for routine stool investigations were included in this study. Naked eye physical examination, microscopic examination was carried out and parasites were identified in the received stool samples. The results were recorded, and data were entered into excel spreadsheet 2007. The percentages of the parasites present were calculated to find out the frequency and distribution.</p> <p><strong>Results:</strong> A total of 1,558 fresh stool samples were screened, of which 20.60% (n=321) were positive for various intestinal parasites. Overall, helminthic infections (81.30%) were higher than protozoal infections (18.70%). On the whole, Ascaris lumbricoides showed higher prevalence (39.56%) followed by Ancylostoma duodenale (19.31%) and Giardia lamblia (9.97%). &nbsp;17(1.09%) of the samples showed more than one parasite. Highest prevalence was seen in age group 15 to 25 years of age (27.40%).</p> <p><strong>Conclusions:</strong> Parasitic infection is endemic. Apart from the early diagnosis and effective treatment, health education is a requisite to control infections in this area and awareness of sanitation to reduce and control parasitic infection.&nbsp;&nbsp;</p> Sanjana Raj Kumari Damodar Sharma Brajesh Jha ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 175 178 10.3126/jcmsn.v15i3.25209 Knowledge on National Free Health Services among Preclinical Medical Students <p><strong>Background: </strong>National free health services are those facilities which are given by the government in free of cost for all the citizens in specific countries. Free health service program provides essential health care services free of charge to all users at Primary Health Care Centers, Health Posts.</p> <p><strong>Methods: </strong>A cross-sectional analytical study was conducted among 395 preclinical medical students Bharatpur, Chitwan, Nepal by using non probability sampling technique. In the Bivariate analysis, Chi-square test was done. Before the binary logistic regression Multicollinearity of independent variables was check by using Variance inflation factor (VIF). Binary logistic regression was performed to examine the net effect of each independent variable on the Dependent variable.</p> <p><strong>Results: </strong>Result showed that 24.8% students had good knowledge on national free health services (with 95% CI 20.81% to 29.3%). The overall level of knowledge of BPH students had good followed by nursing students. Students who were in the age group 20-25 years had 3.54 times (with 95% CI for OR = 1.869 to 6.689) as compared 15-20 years and students of age 25-30 years had 14.04 times (with 95% CI for OR = 5.292 to 37.262) good knowledge as compare to those who were in the age group 15-20 years. Female students had 2 times (with 95% CI for OR = 1.002 to 3.977) good knowledge as compare to male students. Students who were from BDS had 0.83 times (with 95% CI for OR = 0.159 to 4.319), students who were from Nursing had 1.70 times (with 95% CI for OR = 0.658 to 4.402), students who were from BPH had 4.34 times (with 95% CI for OR = 1.698 to 11.087) and students who were from B Pharmacy had 1.10 times (with 95% CI for OR = 0.415 to 2.941) times higher odds of knowledge as compare to those students who were from MBBS.</p> <p><strong>Conclusions: </strong>The overall level of knowledge among the preclinical medical students is poor; only one fourth students had good level of knowledge. Majority of the students don’t know name of the basic free health services provided by government of Nepal. Students of younger adult had good knowledge. BHP and Nursing students had good knowledge as compared to other level. Statistically significant variable with level of knowledge are age (p-value &lt;0.001), gender (p-value 0.049), level of education (p-value&lt;0.001). &nbsp;</p> Hari Prasad Upadhyay Neeti Prasai Meera Prasai Prativa Sedai Sirjana Panthi ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 179 185 10.3126/jcmsn.v15i3.24990 Estimation of Serum and Salivary Sialic Acid Level in Patients with Oral Squamous Cell Carcinoma <p><strong>Background: </strong>Sialic acid is a glycoprotein that is considered as an important constituent of cell membrane. Altered glycosylation is one of the important molecular changes that accompany malignant transformation. Several studies in past have shown that changes in serum and salivary sialic acid levels in cancer patients correlate well with tumor burden. Some of the findings suggested that sialic acid levels could be elevated in cancer patients before the occurrence of clinical symptoms. The purpose of this study is to estimate serum and salivary sialic acid level in oral squamous cell carcinoma patients and correlate their level with the histopathological grading of oral squamous cell carcinoma.</p> <p><strong>Methods: </strong>Blood and saliva samples were collected from 50 patients with oral squamous cell carcinoma and 50 healthy subjects. Serum and salivary sialic acid levels in both free and protein bound forms were measured spectrophotometrically. This was correlated with histopathological grades of oral squamous cell carcinoma. The statistical analysis was done using SPSS software.</p> <p><strong>Results: </strong>A statistically significant rise in serum and salivary sialic acid level was noted in OSCC subjects compared to the controls. Furthermore, significant difference in both serum and salivary sialic acid level was noted between well and poorly differentiated OSCC.</p> <p><strong>Conclusions: </strong>Our report suggests that sialic acid is a valuable biomarker of oral squamous cell carcinoma. It may be used to assess the histological grading of oral cancer and predict the disease outcome and response to the therapy.</p> Pratibha Poudel Barsha Bajracharya Shubrato Bhattacharyya Dipshikha Bajracharya ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 186 190 10.3126/jcmsn.v15i3.23729 Comparative Study of Dexmedetomidine and Fentanyl for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation <p><strong>Background: </strong>Laryngoscopy and intubation cause hypertension and tachycardia which can lead to myocardial ischemia or cerebrovascular hemorrhage in patients with raised intracranial pressure, hypertension. The objective of this study was to compare the efficacy of dexmedetomidine (1 mcg/kg) and fentanyl (2 mcg/kg) in attenuating hemodynamic response to laryngoscopy and intubation.</p> <p><strong>Methods: </strong>Sixty patients scheduled for elective surgeries under general anaesthesia were randomly divided into two groups: Group D and Group F. Group D received dexmedetomidine 1 mcg/kg and group F received fentanyl 2 mcg/kg intravenously over 10 min prior to induction of anesthesia. All the drugs and techniques of anesthesia were standardized in patients in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were recorded at following intervals: at baseline, after drug administration (at 2 and 5 min), after induction, and at 1, 2 and 5 min after intubation.</p> <p><strong>Results: </strong>Heart rate and blood pressure was found to be significantly lower in dexmedetomidine group as compared to fentanyl group at 1, 2 and 5 min after intubation.</p> <p><strong>Conclusions: </strong>Dexmedetomidine 1 mcg/kg is superior to fentanyl 2 mcg/kg for attenuation of hemodynamic response to laryngoscopy and intubation.</p> Sabin Gauchan Chitra Thapa ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 191 196 10.3126/jcmsn.v15i3.25389 Efficacy of Short and Mono segment Spinal Fixations in Traumatic Incomplete Thoracolumbar Burst Fractures <p><strong>Background: </strong>Controversies still mount over the long segment, short segment and mono segment screw fixation for traumatic thoracolumbar spine burst fractures. This article aims to provide our initial experience of the effectiveness of these management modalities with additive focus on their potential benefits upon preventing the loss of correction over time.</p> <p><strong>Methods</strong>: We included all operated cases of thoracolumbar fractures presenting with the ASIA grade of above ‘C’ between December 2014to December 2017 in a retrospective manner in terms of operative time, estimated intra-operative blood loss, any post-operative surgical wound complications, implant cost, average time lapse for the patients to return to physiotherapy and the follow up radiological imaging at 6 months.</p> <p><strong>Results: </strong>Long segment fixation is comparatively more time consuming with considerable blood loss and high incidence of postoperative wound complications. We observed that both short as well as mono segment crew fixations had similar incidences with regards to the common complications pertaining to the spinal implant placement procedures.</p> <p><strong>Conclusions: </strong>Both short and mono-segment fixation procedures resulted in comparable short and long term results. Though long segment fixation is comparatively more stable, it is, however, expensive with a higher incidence of other postoperative complications.</p> Binod Bhattarai Sashi Shah ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 197 201 10.3126/jcmsn.v15i3.26288 Pattern of Major Salivary Gland Malignancy in B.P. Koirala Memorial Cancer Hospital <p><strong>Background: </strong>Salivary gland tumors represent a different variety of histological types. The definite diagnosis of type of salivary gland tumor is required for proper treatment planning. The aim of this study was to evaluate the pattern of salivary gland malignancy in B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan.</p> <p><strong>Methods: </strong>This cross-sectional study was carried out in patients of malignant salivary gland tumor registered in B.P. Koirala Memorial Cancer hospital retrospectively from September 2009 to August 2012.</p> <p><strong>Results: </strong>Parotid gland was the most common sites for malignant salivary gland tumor (80%) followed by submandibular gland (20%). Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of parotid gland and Adenoid cystic carcinoma was the most common malignant tumor of submandibu-lar gland. Male: Female ratio was 1.5:1 with age range from 12 years to 71 years. Common age group for malignant salivary gland tumor was from 50 to 60 years.</p> <p><strong>Conclusions: </strong>Parotid was the most common site whereas Mucoepidermoid carcinoma was the most common malignant tumor of major salivary gland.</p> Rajina Sahi Dilip Karmacharya Dej Kumar Gautam Anil Bikram Karki Amar Shrestha ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 202 205 10.3126/jcmsn.v15i3.23809 Cellular Alteration of the Oral Mucosa due to Orthodontic Appliances and Tobacco Smoking: A Cytomorphometric Study <p><strong>Introduction</strong>: Fixed orthodontic treatment causes chronic low grade irritation on the oral mucosa. Tobacco smoking is considered to be a risk factor in the development of oral cancer. This study involves a cytomorphometric analysis on the buccal mucosal cells in patients undergoing fixed orthodontic treatment who are tobacco smokers.</p> <p><strong>Methods</strong>: Exfoliated buccal mucosal cells were obtained from orthodontic patients (smokers &amp; non-smokers) as well as smokers and non-smokers who are not undergoing any orthodontic treatment. Smears were stained with rapid PAP stain and digital images of 50 cells were analysed using the Image J software.</p> <p><strong>Results:&nbsp;</strong>Statistical analysis revealed that there were significant increase in the values of nuclear and cell diameter between non-smokers undergoing orthodontic treatment and smokers (p&lt;0.001 &amp; p=0.014 respectively), and between non-smokers undergoing orthodontic treatment and smokers undergoing orthodontic treatment (p&lt;0.001 &amp; p=0.015 respectively). Also, nuclear area and cell area showed significant differences between many of the study groups.</p> <p><strong>Conclusion</strong>: It can be concluded that there are nuclear and cellular alterations in patients undergoing fixed orthodontic treatment who are smokers</p> Vinay Marla Dharanidhar Baral Prabhat Ranjan Pokharel Ashish Shrestha Rajesh Gyawali Jamal Giri ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 206 210 10.3126/jcmsn.v15i3.22620 Prevalence of Extended Spectrum Beta-Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolated from Urinary Tract Infected Patients Attending Tertiary Care Hospital of Central Nepal <p><strong>Background: </strong>Urinary tract infection (UTI) is one of the major health problems in Nepal. <em>Escherichia coli </em>(<em>E</em>. <em>coli</em>) and <em>Klebsiella pneumoniae </em>(<em>K</em>. <em>pneumoniae</em>) are two important bacteria associated with UTI. This study was designed to assess the prevalence of extended spectrum beta-lactamase (ESBL) producing <em>E</em>. <em>coli </em>and <em>K</em>. <em>pneumoniae </em>in urinary isolates at College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal.</p> <p><strong>Methods: </strong>We aseptically received 5564 mid-stream urine samples of suspected UTI patients from September 2016 to August 2018. The randomly collected 5564 urine samples were processed by standard Microbiological guidelines as recommended by Clinical and Laboratory Standards Institute (CLSI). All isolates including <em>E. coli </em>and <em>K. pneumoniae </em>were identified using the specific biochemical and sugar fermentation tests. Antibiotic sensitivity test was performed for all the isolates against all commonly used antibiotics by modified Kirby-Bauer disk diffusion method and interpreted following CLSI guidelines. First performed initial screening method then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT).</p> <p><strong>Results: </strong>Out of 5,564 urine specimens investigated, <em>E. coli </em>was isolated in 1219 (63.99%) and <em>K</em>. <em>pneumoniae </em>in 223 (11.70%) cases. Initial screening revealed 615 (50.45%) isolates of <em>E. coli </em>and 127 (56.95%) <em>K</em>. <em>pneumoniae </em>to be resistant. Further testing by PCDDT method confirmed 102 (16.58%) <em>E</em>. <em>coli </em>and 25 (19.68%) <em>K</em>. <em>pneumoniae </em>isolates to be ESBL producers. These ESBL producers’ uropathogens revealed high degree of resistance to cephalosporins (100%) and quinolones (52%-92%) group of antibiotics.</p> <p><strong>Conclusions: </strong>In our study the prevalence of ESBL producing <em>K</em>. <em>pneumoniae </em>was found to be 19.68%, those of <em>E</em>. <em>coli </em>was to be 16.58% by PCDDT. In this study, all ESBL producing <em>K</em>. <em>pneumoniae </em>isolates were sensitive (100%) to meropenem and <em>E</em>. <em>coli </em>showed 98.04% sensitive to meropenem. Hence, for the treatment of these ESBL infections, currently, carbapenems are the recommended drug of choice.</p> Surya Narayan Mahaseth Raj Kumari Sanjana Brajesh Kumar Jha Khilasa Pokharel ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 211 217 10.3126/jcmsn.v15i3.22602 Prevalence of Psychological Problems Among Adolescent Students of Selected Private School at Itahari Sub-Metropolis of Eastern Nepal <p><strong>Background: </strong>Adolescence is the second decade of life, the crucial period demanding significant adjustment in physical, psychological and social dimensions. The main aim of this study was to access the psychological problems of adolescents in Itahari sub-metropolis.</p> <p><strong>Methods: </strong>A cross-sectional study design and consecutive sampling technique was adopted for the study. The study was conducted in selected schools of Itahari Metropolitan city. From the selected schools, students of class 7 to 12 with the age range of 11-19 years were included in the study. Sample size was calculated considering the prevalence of Psychosocial Problem of similar setting. The instrument for data collection was self-administered pediatric checklist for youth, an internationally valid tool, which was divided in three parts. Part I related to socio-demographic information, part II consisted of questions regarding family and school related factors and part III was the standard tool to measure psychosocial problem.</p> <p><strong>Results: </strong>The prevalence of psychological morbidity on the basis of total difficulties score was found to be 23.9% (11) in male whereas 31.5% (17) was abnormal in female. Among males, 76.1% (35) was found to have normal scores as compared to 68.5% (37) in females although the difference was found to have no statistical significance.</p> <p><strong>Conclusions: </strong>The adolescent age groups have to face various psychological problems and are likely to be very common. School mental health and social services have the potential to affect the prevalence of these and other psychological disorders by assisting in the assessment, referrals and management of the affected students.</p> Parth Guragain Hem Sagar Rimal Tara Kafle ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 218 221 10.3126/jcmsn.v15i3.24977 Dynamic Hip Screw (DHS) versus Proximal Femoral Nail Anti-rotation (PFNA) Fixation for Unstable (Evans-Jensen II and III) Inter-trochanteric Fractures of Femur in Elderly <p><strong>Background:</strong> Dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) are the two most commonly used fixation devices for inter-trochanteric fracture of femur. However, many clinical studies have shown lack of differences in the&nbsp; clinical outcome consistently with between these two fixation techniques. The main objective of this study is to&nbsp;compare the results of dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) fixation in elderly patients with unstable inter-trochanteric fractures of femur.</p> <p><strong>Methods: </strong>We retrospectively reviewed patients who underwent operative management for inter- trochanteric fractures of femur in our hospital between February 2013 and September 2017. Elderly &nbsp;&nbsp;patients (Age &gt;60yrs) with unstable inter-trochanteric fracture of femur treated either with DHS fixation or with PFNA fixation were included and divided into two groups: DHS fixation group and PFNA fixation group. The comparative statistical analysis was done between two group using following &nbsp;&nbsp;parameters: average length of the incision, operation time, blood loss, fracture healing time, and degree of postoperative functional recovery.</p> <p><strong>Results:</strong> The mean follow-up period, in DHS fixation group was 16 month (range 12 to 24 months) and in PFNA fixation group was 14 months (range 12 to 18 months). The differences between two groups regarding average length of the incision, operation time, and blood loss were statistically significant (p&lt;0.05) and better in PFNA group whereas the differences between two groups regarding fracture healing time and the degree of postoperative functional recovery were not statistically significant (p &gt;0.05).</p> <p><strong>Conclusions:</strong> PFNA fixation may be &nbsp;better than DHS fixation for the treatment of unstable inter-trochanteric fractures of the femur in the elderly. However, the application and usage of DHS fixation could not be neglected and the choice of treatment depends upon the systemic condition and socioeconomic status of the patient, patient’s preferences, surgeon’s experience and availability of treatment facility.</p> Manoj Kandel Robin Shrestha Krishna Prasad Poudel Shrawan Thapa Sushil Thapa Sunil Panta ##submission.copyrightStatement## 2019-10-01 2019-10-01 15 3 222 225 10.3126/jcmsn.v15i3.25554