Journal of College of Medical Sciences-Nepal

Awareness and Practice Patterns Among Pediatricians Regarding Retinopathy of Prematurity at Bharatpur, Chitwan, Nepal

Manisha Shrestha, Puspa Giri Shrestha, Ranjeet Sah, Kumudini Subedi — Mon, 01 May 2023 00:00:00 +0000

Introduction
Retinopathy of prematurity (ROP) is a disorder of the developing retina of preterm infants due
to defective vasculogenesis that can lead to incurable blindness. It can be prevented by timely
detection and treatment. The study aimed to analyze the level of awareness, knowledge and
practice of Pediatricians regarding ROP in Bharatpur.

Methods
This was a quantitative, cross-sectional study using self-administered questionnaires to assess the
awareness level among pediatricians at the main hospitals of Bharatpur City. A scoring system was
implemented in the data analysis, depending on the correct chosen answers on the questionnaire.
The ethical approval was obtained from the Institutional Review Committee of NNJS (Reg. no. 15/
2022).

Results
Forty-three pediatricians from 11 hospitals in Bharatpur Metropolitan City filled out the
questionnaires. The mean age of the participants was 35.53 ± 9.09 years (25 to 68 years), majority
being male (N=28; 65.12%). More than half of the participants, 23 (53.49%) had a knowledge score
of 10-15. The knowledge score was 0-5 and >20 in 6 (13.95%) and 2(4.65%) participants respectively.
Men were significantly more knowledgeable about ROP than women (p = 0.02).

Conclusions
This study has projected the level of understanding about ROP among pediatricians in Bharatpur.
Workshops and courses on ROP screening criteria and referral are recommended specifically
for pediatric residents and pediatricians in the early stages of their careers. There should be
coordination and good referral network between Pediatricians and Ophthalmologists.

Prevalence of Bullying in Undergraduate Students at a Medical College of Nepal

Mukta Singh Bhandari, Jagdish Chataut — Mon, 01 May 2023 00:00:00 +0000

Introduction
Bullying is a common problem affecting physical and mental health as well as academic performance of students. It also results in harmful coping behaviours like indulgence in alcohol, drug abuse and college drop out. Compared to students from other streams, the proportion of bullying among medical students is very high. The objective of this study was to determine the prevalence of bullying among students in a medical college of Nepal.
Methods
A cross-sectional study was carried out amongst students of Kathmandu University School of Medical Sciences, enrolled in MBBS stream during the period of September 2021 to July 2022. Ethical approval was taken from Institutional review committee of the institute (Approval number: 76/2021). A semi-structured, self-administered questionnaire was used. Descriptive statistics were performed and Chi-square Test was done.
Results
The prevalence of bullying in this study was 78% (203) and 145 (71%) of the victims were male. Verbal bullying by classmates and others was 153 (75%) while non-verbal bullying by teacher/ instructor was 120 (59%). Only 50 (24%) had ever complained about bullying and out of 50 complains, 27 (54%) said action was taken but bullying didn't stop in 33 (66%) of the cases. Out of 156 students who didn't complain, 57 (37%) students felt that it was not a big issue.
Conclusions
Bullying is a very common problem among medical students however most of the students take it lightly and no action is taken after complaining. Thus, students should be made aware about bullying and serious action should be taken against it.

Histopathological Spectrum of Neoplastic Lesions of Female Reproductive System at a Tertiary Care Hospital in Bharatpur, Chitwan

Mamata Sedhain, Priya Pathak, Binita Goyal, Pratigya Subedi — Mon, 01 May 2023 00:00:00 +0000

Introduction
Malignant neoplasms of the female genital tract accounts for majority of the cancers in females. The incidence and pattern of malignancies vary from region to region due to differences in genetic patterns, lifestyle and sociocultural factors. The objective of this research is to study the histopathological spectrum of neoplastic lesions of female reproductive system.

Methods
A total of 309 samples of neoplastic lesions were included in the study from the period of January
2017 to December 2021.

Results
Most of the neoplastic lesions were found in the uterine corpus, followed by ovary, breasts, cervix and vulva. 80.25% of the neoplastic lesions were benign and 11.97% were malignant; the rest being premalignant and borderline categories.

Conclusions
Malignant neoplasms of female genital tract contributes to major cancer burden among women and therefore special measures should be adopted to reduce its incidence and improve the prognosis

Antimicrobial Sensitivity Pattern of Causative Agents of Urinary Tract Infection in Children Between 1 to 15 Years

Vijay Kumar Sah, Sunil Kumar Yadav, Arun Giri, Sandip Kumar Singh — Mon, 01 May 2023 00:00:00 +0000

Background: The presence of actively multiplying organisms in the urinary tract implies urinary tract infection. Although it is infrequently associated with mortality, it is still an important cause of morbidity in the pediatric age group. Prompt diagnosis and early initiation of appropriate antibiotics in children reduce the morbidities associated with urinary tract infection. The objective of the study was to find out the causative agents of urinary tract infections and their antibiotic sensitivity pattern in pediatric patients.

Methods: This was a cross-sectional study conducted in the department of pediatrics over a period of 12 months and 80 patients fulfilled the inclusion criteria. The modes of presentation, laboratory investigation reports which included urine routine microscopy, bacterial isolates with colony count from the urine culture, and antibiotic sensitivity pattern were documented. Descriptive statistics were used for analysis of data.

Result: Escherichia coli was the most common organism isolated (55.9%). Most of them were sensitive to amikacin.The highest degree of resistance was noticed with ampicillin.

Conclusion: Aminoglycosides like amikacin can be considered as first-line drugs in urinary tract infection.

Keywords: antibiotics, children, urinary tract infections.

Analgesic Efficacy of Diclofenac and Ibuprofen/Paracetamol Combination in Post Extraction Cases

Mon, 01 May 2023 00:00:00 +0000

Introduction

Postoperative pain management is essential post-extraction for early mobilization and rehabilitation to enhance recovery and to reduce morbidity. Diclofenac and Ibuprofen and Paracetamol combination are two most common NSAIDs used in the postoperative pain control.

Methods

Two hundred fifteen patients (n=215) of age group 20-60 years who underwent extraction of upper or lower third molar impacted teeth were divided randomly into two groups (T1 and T2). T1 group (n=105) received Tab. Diclofenac 100mg and T2 group (n=110) received Tab Ibuprofen and Paracetamol combination. Analgesic efficacy of Diclofenac was compared with that of Ibuprofen and Paracetamol combination at post-op day 1, day 3 and day 5. Analgesic efficacy was measured using Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS).

Results

Pain intensity decreased significantly at all the time points in both the groups. The analgesic efficacy of Diclofenac was significantly higher than Ibuprofen and paracetamol combination as estimated by VAS mean score at day 1 and day 3 post-operative period (p<0.001).But based upon the VRS mean score at post-opearative day 1, day 3 and day 5, there was no statistically significant difference between two treatment groups.

Conclusions

This study showed that Diclofenac potassium was more effective than Ibuprofen and Paracetamol combination for reducing postoperative pain associated with extraction of third molar impaction. Few number of patients in both treatment groups developed gastrointestinal upset.

MRI Evaluation in Acute Spinal Trauma in Tertiary Center of Nepal

Mon, 01 May 2023 00:00:00 +0000

Introduction
Spine injury is one of the leading caused for disability in Nepal. Patients with trauma related spine injury leads to neurological dysfunction, focal deficits and even fatal life threating events. The timely intervention in acute spinal trauma injury could save the patients from disability and mortality risk. Imaging modalities like Xray, CT Scan and MRI helps in diagnosis and management of spinal trauma. MRI plays crucial role in detection of spinal cord and soft tissue injuries. It is
superior than CT scan in evaluation of spinal cord injuries, ligament, soft issue structures, disc, and occult osseous injuries. The objective of this research is to evaluate MRI in acute spinal trauma in tertiary center of Nepal.

Methods
This is descriptive hospital based observational study in those patients who were admitted and referred in hospital for MRI with acute spinal trauma injury. Data were analysed by SPSS 2022.

Results
Acute spinal trauma is most common in male with ratio of 1.7 with the mean±SD of age was found to be 50.98±19.26 years. Most common mode of injury were fall injury (76%). Most common spinal region involved were lumbar (42%) followed by thoracic (36%), dorso-lumbar (14%) and cervical (8%) region respectively. Spinal cord contusion with edema, disc rupture, paravertebral collection and ligament injury were seen. Most common type of fractures were simple compression fracture (72%), followed by burst fracture (16%), both (6%) and listhesis and sub/dislocations (6%). Spinal
cord injury were seen in 22%, followed by disc rupture, paravertebral collection and ligament injury.

Conclusions
MRI helps in evaluating vertebrae, spinal cord, ligament and disc injuries. We can assess the cord contusion, edema and canal compression. It provides involvement, extension and severity of cord injury. It endowed about outcome of surgery as well as conservative management in patient of spinal injury.

Analysis of Histopathological Artifacts in Oral Biopsy Specimen: A Descriptive Cross Sectional Study

Pratibha Poudel, Bhoj Raj Adhikari — Mon, 01 May 2023 00:00:00 +0000

Introduction

Arriving at the final diagnosis requires the histopathological examination of the biopsied lesion. Many a times, diagnosis of lesion may be hindered due to presence of artifacts in the slide. Having a thorough knowledge of these artifacts help to take the precautionary measures to avoid their occurrence. This study is an attempt to analyze histopathological slides from Department of Oral Pathology to identify the artifacts seen in oral biopsy specimens.

Methods

This cross sectional study was conducted in Department of Oral Pathology, Dhulikhel Hospital from July 2021 to February 2022. Slides of all the biopsies during the study period were included in the study. The artifacts were divided into three groups: Artifacts related to surgeons performance, artifacts related to technicians performance and artifacts caused during transfer of sample to the laboratory. Then, the frequency distribution for each type of artifact was calculated.

Results

A total of 280 slides were included in the present study. Artifacts related to technicians performance were seen in 89.3% slides whereas artifacts related to surgeons performance were seen in 76.4% slides. None of the slides showed artifacts related to transfer of sample to the laboratory. The most common artifact seen was eosin leaching (63.6%) followed by stain deposit (60%) and folds and wrinkles (40.7%).

Conclusions

The findings of our study showed that various types of artifacts may be incorporated in biopsy specimen that create difficulty in diagnosing the lesion properly. Proper biopsy protocol and careful handling of sample to prevent technical errors may be helpful to reduce the frequency of artifacts.

Stone Free Rate of Lower Pole Calyceal Stone Versus Other Calyces in Retrograde Intrarenal Surgery

Rajiv Shah, Tika, Deepak Adhikari — Mon, 01 May 2023 00:00:00 +0000

Background:

Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery (RIRS) and laser in combination has already proven their superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the stone-free rate (SFR) of lower pole calyceal stone versus other pole calyces in RIRS.

Methods:

This retrospective study analyzed the stone free rate of lower pole calyx stone versus other pole calyces in retrograde intra renal surgery (RIRS) adults above 15 years of age from March 2021 to February 2022 at Chitwan Medical College and Teaching Hospital, Nepal. The stone-free rate was assessed descriptively on post operative complications, stone size, operative time, hospital stay, and need for the second procedure.

Results:

A total of 62 patients underwent retrograde intrarenal surgery. The mean age of the study population was 38.41 ± 10.54years in the lower caliceal group against 39.09 ±13.53 years with p value of 0.829.The mean hounsfield of lower caliceal stone was 1023.31±252.96 to that of other caliceal stones 1004.00±349.22 with p value of 0.806.

The sizes of the stones were 11.07±2.10 mm in lower caliceal stones versus 10.67±2.51mm in other caliceal stones with p value of 0.507.

The duration of operation time in 1^st group was 63.82±23.57minutes to that of 65.93±28.96 in 2^nd group with p value of 0.756.

The hospital stay in lower caliceal stones were 6.13±1.43days to that of other caliceal stones 5.87±0.99 with significant p value of 0.412.

There were no major complications in both arms.

The stone free rate was 25 (86.2%) in lower caliceal stones as compared to 31(93.93%) in other caliceal stones with no significant p value of 0.405.

Conclusions:

Retrograde intrarenal surgery is a better procedure that continues to undergo significant advancements. It is a technically safe and effective procedure for the treatment option for treating the lower pole calyx calculus with optimal post-surgical morbidity and stone-free rate.

Clinical Characteristics and Results of Transungual Excision of Subungual Glomus Tumor

Suresh Pandey — Mon, 01 May 2023 00:00:00 +0000

Introduction
Glomus tumor is rare and subungual location of the distal phalanx is the most common site. Surgical excision is the mainstay of treatment to relieve the symptoms. The objective of this study was to analyze the clinical characteristics and result of transungual excision of the tumor.
Methods
A retrospective cross sectional study of was conducted among 15 cases of subungual glomus tumors operated with transungual excision over 8 years period in the department of Orthopedics. The clinical and demographic characteristics were noted from the case record. The outcome variables were assessed from case records, OPD visits, and telephone interviews and the results analyzed were pain relief, postoperative recurrence, nail deformity, and patient satisfaction. Data was analyzed by using descriptive statistical tools in SPSS-20.
Results
The mean age of the patients was 32.6 years with the mean duration of symptoms 1.8 years. The mean tumor size was 3.4 mm. Pain and pinpoint tenderness were present in all 15 cases and positive cold sensitivity test and positive Hildreth’s test in 13 (86.7%) and 10 (66.7%) cases respectively. All cases had complete relief of pain within 2 weeks of the operation. There was no case of recurrence and nail deformity till a minimum of 1 year of follow up.
Conclusions
The diagnostic clinical triad of pain, point tenderness, and cold sensitivity are the most common findings. The transungual excision of the tumor can give rise to excellent results with complete relief of pain in all cases with no recurrence or nail deformity.

Molecular Characterization of Moraxella Catarrhalis and it's Antibiotics Susceptibility Patterns from Different Respiratory Tract Infection Patient's Clinical Samples

Brajesh Kumar Jha, Hari Prasad Upadhyay, S Mahadevamurthy, J Sudisha — Mon, 01 May 2023 00:00:00 +0000

Introduction
Moraxella catarrhalis is a gram negative, oxidase positive, cocci mainly causing upper and lower respiratory tract infections. The RND family efflux pumps lead to multidrug resistance in most of the gram negative bacteria. One of the well- known pumps in M. catarrhalis is arcAB and oprM system. The objective of this study was to investigate the antibiotic resistance in M. catarrhalis and to determine its resistance dependence on the efflux pump.

Methods
In this study, 283 different respiratory tract infection samples processed out of that 73 were confirmed by biotyping and molecular characterization as a M. catarrhalis. The antibiotic susceptibility tests were performed by disc diffusion method according to CLSI. Molecular characterization for multidrug resistance isolates was also done along with genes responsible for efflux pumps. PCR was done M. catarrhalis and acrAB and oprM genes. The factor for association of efflux pump with antibiotic resistance was investigated using phenylalanine argine β-naphthylamide.

Results
The antibiotics susceptibility result showed 12 out of 73 isolates were MDR, selectively taken for PCR using 16SrRNA specific primer. The MDR isolates were further confirmed by PCR. The amplification results of acra, acrb and oprm genes for the M. catarrhalis having multidrug resistance genes by PCR band size products seen on 2% agrose gel. The highest resistance towards the drugs viz penicillin, ampicillin, amoxicillin, amoxiclave, cotrimoxazole, cefazolin, cefuroxime, ceftrixone and cefepime were seen in M. catarrhalis.

Conclusions
The result showed that Moraxella catarrhalis is one of the major causes for respiratory tract infection. The drug resistance in this species is increasing day by day. The 90% of isolates have acrAB and oprM genes for efflux pump responsible for multiple drug resistance. The efflux pump inhibitor has important clinical significance for the proper treatment.

Comparative Study of Serum Vitamin D and Calcium in Patients With and Without Temporomandibular Joint Disorder: An Institutional Study

Anuja Panthee, Asmita Panthee, Anju Khapung — Mon, 01 May 2023 00:00:00 +0000

Introduction

Calcium homeostasis, an essential component of musculoskeletal system requires Vitamin D as its integral element. Many studies have demonstrated the inconclusive association between serum calcium and some factors involved in calcium metabolism such as vitamin D.

Objectives

The aim of this present study is to evaluate the serum level of vitamin D and calcium in patient with and without Temporo-mandibular Joint disorder (TMDs) and to determine the association of same with age and gender.

Methods: An observational, comparative, quantitative, cross sectional study was done over a period of 6 months. Serum analysis of vitamin D and calcium was done for patients, with and without TMDs, visiting Oral and Maxillofacial Surgery (OMFS) Out Patient Department (OPD) from May to october 2022. Data analysis was done using chi square and independent t test.

Results

A total of 200 study participants were included in the study of which 100 (50.00%) had TMDs and 100 (50.00%) did not have those problems. The difference in Vitamin D level were found statistically significant in those with and without TMJ problems.

Conclusion

There was statistically significant association between serum Vitamin D and TMDs whereas there was no association between serum calcium and TMDs.

Outcome of Covid-19 Patients Admitted in Emergency Department of Karnali Academy of Health Sciences, Teaching Hospital

Mon, 01 May 2023 00:00:00 +0000

Introduction

COVID-19, a global health problem, was first identified in the Hubei province, China. While various clinical features of the diseases have been documented, the complete clinical profile is yet to be understood. The purpose of this study is to evaluate the outcome of Covid-19 after admission in the emergency of KAHS during the year 2021January – 2022 January.

Methods

This is a hospital-based, retrospective, observational study done in the emergency department of Karnali Academy of Health Sciences (KAHS), Jumla. The data was taken from the registry, including the record files of patients with Covid-19 admitted in the hospital from 2020 January to 2021 January. The retrieved data was initially entered in an Excel sheet followed by its analysis. We carried out Kaplan Meier survival distribution analysis to determine the survival probability and predictors of Covid-19.

Results

Of the 516 Covid-19 positive patients who were admitted in the hospital, 53.5% were males. For the total patients, the mean duration of hospital stay was 8.02±5.32 days with the proportion of patients who died during treatment being 3.7% (n=19). As described by the Kaplan-Meier curve and the accompanying survival table, the mean survival time of the overall patients was 36.74 days (95% CI=35.6–37.8). Moreover, the cumulative survival rate was seen prominently decreased for older patients and those admitted in the intensive care unit and/or ventilator.

Conclusion

The increased mortality rates seen in the older patients and those admitted in critical care setting clearly calls for the importance of proper and timely intervention.

Anthropometric Measurement of Mastoid Process Using Multidetector Computed Tomography

Prabhat Basnet, Hari Prasad Upadhyay, Rajib Chaulagain — Mon, 01 May 2023 00:00:00 +0000

Introduction
Mastoid process is one of the most important landmark of the skull. It is a part of temporal bone and contains air filled space which is called mastoid air cells. It is also an attachment of different neck muscles. Normal measurement of the mastoid process is very important for surgeons' point of view. This study was aimed to assess the normal dimension of mastoid process.

Methods
The study was a descriptive cross-sectional study conducted on 104 patients, at Department of Radiology and Imaging, College of medical sciences, Bharatpur, Nepal. All CT examinations were performed using Toshiba 160 slice CT scanner. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS, Inc., an IBM Company, Chicago, IL). Descriptive statistics was used to analyze the data.

Results
Among the 104 patients who participated in the study, 38 (36.5%) were male and 66 (63.5%) were female. All the measurements of mastoid process taken in males were higher than in females except the anterior inclination angle which was more in female on both right and left side. The volume of mastoid process in males was 14.16±5.3 and 14.69±6.6 on right and left side respectively while in female it was less.

Conclusions
The present study estimated the normal dimension of mastoid process. The normal dimension of mastoid process in male is larger than in females.

Prevalence of Post Infectious Glomerulonephritis (PIGN) and Associated Complication

BalaKrishna Kalakheti, Brajesh Raj Chaudhary, Hari Prasad Upadhyay — Mon, 01 May 2023 00:00:00 +0000

Introduction

Post infectious glomerulonephritis (PIGN) is the most common renal disease in children causing significant morbidity. The affected children present with features of acute nephric syndrome (hematuria, hypertension, edema and oliguria. The objective of this study was to determine the prevalence, clinical characteristics, complications, and outcomes of children presenting with post infectious glomerulonephritis in paediatric ward of tertiary care hospital.

Methods

This was a prospective observational study conducted at a tertiary care hospital in Chitwan, Nepal from March 1^st 2020 to February 28^th 2021. Children aged 4 – 15 years satisfying 2 out of 4 features of acute nephritic syndrome were included in the study. After discharge, patients were followed up at 4 weeks and 8 weeks. Data entry was done in statistical packages for the social science version 20.

Results

Among 63 children recruited with acute nephritic syndrome, 73% had Post infectious glomerulonephritis. The most common etiology of PIGN was Post streptococcal glomerulonephritis (63%). The mean age of children was 11.2 (±3.2) years. Males to females’ ratio was 1.5:1. The most common presenting feature was edema (100%). The most common complication was acute kidney injury (41.3%).

Conclusion

Post infectious glomerulonephritis was the most common cause of acute nephritic syndrome in children. High incidence of life-threatening complications like CCF, retinopathy, encephalopathy and renal insufficiency occur that require close monitoring and timely intervention to prevent morbidity and mortality.

Prevalence and Associated Factors of Menstruation Pattern Among Schools Adolescents

Meera Prasai, Hari Prasad Upadhyay, Srijana Panthi, Kamal Khadka, Roshan Kuwar — Mon, 01 May 2023 00:00:00 +0000

Introduction
Menstruation, also known as a period, is a natural process that occurs in the female body as a part of the menstrual cycle. The menstrual cycle is the monthly hormonal cycle that prepares the female body for pregnancy. The objective of this research is to find the prevalence and associated factors of menstruation pattern among schools adolescents.

Methods
A descriptive cross sectional study was conducted among 355 adolescent girls of (10-19 years) in five boarding and government school of Bharatpur municipality, Chitwan. Self- structure questionnaire was then distributed to those students who had already attended their menstruation. Data was entered and analyse by using descriptive and inferential statistical tools in SPSS 20. P-value <0.05 were considered as statistically significant.

Results
The mean±SD of age was found 14.60±1.54 years. In 63.9% (With 95 %CI 58.9% to 68.9%) students had irregular menstruation cycle. Likewise18.87% students had Oligomenorrhoea, 17.18% had Polymenorrhoea and 11.3% students had menorrhagia. Family history of students was found as statistically significant with menstruation problem (p-value<0.05).

Conclusions
Dysmenorrhea, Irregularities in menstruations cycle and Pre menstruation symptoms was found to be major problems in adolescents girls.

An Early Experience of “Hanging Maneuver of Liver resection":A Cross-Sectional Study

Mon, 01 May 2023 00:00:00 +0000

Introduction

The posterior approach to liver resection is technically difficult, especially when there is a bulky tumor or dense adhesion of right lobe of liver with the risk of tumor dissemination and hepatic vein avulsion. To prevent this, anterior approach of liver resection was used; however, it is technically challenging and can lead to a false line of transection and difficulty in controlling bleeding in deeper parenchymal plane. These technical difficulties are overcome by hanging maneuver liver resection which eases the process of anterior approach. The Objectives of our study were to observe the technical safety, operative duration, operative blood loss, and perioperative complications of hanging maneuver in liver resection.

Methods

This is a cross-sectional study on the patients who underwent hanging maneuver of liver resection at our center. The perioperative data were analyzed. Descriptive variables were described using frequency and percentage; continuous variables were described using mean and standard deviation.

Results

A total of 15 patients underwent hanging maneuver of liver resection, majority were male (66.6%) with Child-Pugh score-A of 80%. The most common indication was complex hydatid cyst of liver (33%) and biliocutaneous fistula (13%) that occurred after previous intervention for hydatid cyst of liver (13%). Intraoperative blood loss was 750±343.2 ml and complications grade IIIA were up to 20% as per Clavien Dindo grading system.

Conclusions

Hanging maneuver of liver resection is a technique that facilitates in elevating liver parenchyma away from IVC and helps in an easier anterior approach. A learning curve and assessment of background liver disease is necessary for its safety.

S.T.O.N.E. Score in Prediction of Stone Clearance in PCNL

Sudeep Raj K.c, Bhusan Raj Timilsina, Dipesh Kumar Kushwaha, Saroj Giri — Mon, 01 May 2023 00:00:00 +0000

ABSTRACT

Background

S.T.O.N.E. score has been considered as standard scoring system for prediction of complication and to state the clearance of the stone. The objective of this research is to find out STONE score in predicting percutaneous nephrolithotomy (PCNL) success in stone free rate.

Methods

A cross sectional study was conducted in the department of urology in College of Medical Sciences and Teaching Hospital. Seventy five case of patient who underwent PCNL were included in the study and S.T.O.N.E. score was gathered like stone size, tract length (skin-to-stone distance), degree of obstruction (presence of hydronephrosis), number of involved calyces and stone essence (stone density). Collected data was entered and analyzed using SPSS.

Results

Among the total of 75 patients 40% (with 95% CI as 28.91% to 51.08%) had residual stone while remaining had no residual stone. 90.7% patients had 0-399 mm stone size, 97.3% had less than 100 mm tract length and likewise 29.3% had moderate to severe dilatation. Majority (68%) had 2-3 calyces involment and 72% had more than 950 HU stone density.

Conclusion

S.T.O.N.E. nephrolithometry is highly predictive of stone free status in patients undergoing PCNL and provides a quick, easy-to-apply method for grading the complexity of PCNL

Retrospective Study of Autologous Arteriovenous Fistula Creation as Vascular Access for Hemodialysis

Bijay Sah, Lokesh Shekhar Jaiswal, Rakesh Kumar Gupta — Mon, 01 May 2023 00:00:00 +0000

Introduction
An autologous arteriovenous fistula (AVF) creation is a common vascular procedure for hemodialysis (HD) patients. This surgical procedure aim is to design a vascular conduct that withstands hemodialysis for a durable period. However, the functional outcome of this procedure varies and depends on patients’ various predictors.
Methods
A retrospective observational study was carried out to evaluate the functional outcome of AVF creation at the cardiothoracic vascular surgery unit of the surgery department of B.P Koirala Institute of Health Sciences from February 2019 to February 2020. The medical file of the patients was studied, relevant data entered and analyzed in SPSS statistical software.
Results
There were a total of 112 autologous AVF created during the study period. The mean age of the patients was 48.66±15.64 years. There were 75(67%) males and 37(33%) females. The most common limb of fistula creation was left non-dominant upper limb 95(84.8%) and right upper limb 17(15.2%). The most common type of AVF was radiocephalic fistula 66(58.9%) and brachiocephalic fistula 46(41.1%). There were 92(82.1%) mature fistula at eight weeks follow-up. These include
54(48.2%) radiocephalic fistulas and 38(33.9%) brachiocephalic fistulas. There were 20(17.8%) delayed matured fistulas at 12 weeks (12 radiocephalic and 8 brachiocephalic AVF).
Conclusions
The creation of an autologous AVF for hemodialysis in the upper limb has fewer complications and the maturation of the AVF depends on the vessel’s diameter. Radio-cephalic and Brachiocephalic AVF usually matures between six to eight weeks duration

Rectal Foreign Body Causing Perforation: A Case Report

Mon, 01 May 2023 00:00:00 +0000

The rectal foreign body is a rare presentation with rising incidence. We present a case of a 26-year-old heterosexual male with an alleged history of sexual assault with insertion of a large foreign body through the anus two days prior with peritonitis. After investigations, the patient underwent an exploratory laparotomy, foreign body removal, primary repair of perforation with a diverting colostomy. Diversion must be considered in cases where the extent of anal sphincter mechanism injury is in question. The patient had a good outcome. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of perforation.