Journal of Gandaki Medical College-Nepal

Synchronous use of two markers of research: p-value and confidence interval

Krishna Subedi — 2022-12-31

No abstract

Feedback of the faculty participants on training workshop on developing multiple choice questions

Rano Mal Piryani — 2022-12-31

Introduction: Multiple choice questions are commonly used tools for the written assessment of undergraduate health professions students. Faculty members need training for the development of valid and reliable multiple choice questions. For this purpose, Bilwal medical college organized one-day training workshop on developing multiple choice questions for newly recruited faculty members in March 2021. The main objective of the study was to assess the feedback of the participants on training workshop.

Methods: This descriptive cross-sectional study assessed the feedback of the participants of training workshop on developing multiple choice questions. The feedback questionnaire had four questions. First was on “rating training workshop on scale 1 to 10 (1=poor, 10=excellent) for usefulness, content, relevance, facilitation and overall”. Second was on confidence of the participants in developing MCQs after participation based on Likert scale 1 to 4 (1=not confident to 4=extremely confident). Third was on perceptions of the participants on strengths of training workshop. Lastly, fourth was on areas for improvement. The data was analyzed for central tendency using microsoft excel.

Results: Participants’ feedback rating about usefulness (8.82±1.51), content (8.12±1.69), relevance (8.35±1.46), facilitation (8.41±1.46) and overall (global) rating (8.35±1.41) was remarkable. Their confidence level after participation (3.41±0.51) was noticeable.

Conclusions: The perceptions of the participants immediate after the training workshop i.e, their reaction was positive.

Study of academic performance in medical students at the time of COVID-19 pandemic

Neebha Amatya — 2022-12-31

Introduction: The world has faced a disastrous period at the time of the pandemic of corona virus- 19. The education system was hampered along with all the sectors of life and therefore, it was realized that a switch from the conventional way of teaching to online teaching is needed. The current study was done to analyze the impact of the COVID-19 lockdown on the academic performance of medical students at Gandaki medical college of Pokhara, Nepal.

Methods: It was a descriptive study of the first and second-year medical students of Gandaki Medical College. The Likert scale was used to measure the effect of the COVID-19 lockdown on academic performance and to evaluate online education. A census sampling technique was used to collect the data.

Results: A total of 171 participants answered the questionnaire with a response rate of 87%. The data showed that covid-19 lockdown affected the academic performance of most participants of 98.2% with varying degrees. The mean evaluation score for online theory education was 4.7±2.06 while for the practical lessons was 2.06±1.4.

Conclusions: COVID-19 pandemic lockdown affected the academic performance of most participants to varying degrees. The academic performance of medical students with the online teaching method is effective during COVID-19 lockdown.

Is daycare tonsillectomy a safe outpatient surgery at Pokhara ENT Center, Nepal

Rajendra Nepali — 2022-12-31

Introduction: Tonsillectomy is one of the most common surgical procedure in the world performed by Ear, Nose and Throat surgeon. Over the past decade, there has been progress in surgical techniques for tonsillectomy, yet pain and bleeding after tonsillectomy remain important surgical complications. With the increasing need to reduce healthcare costs in developing countries, there is currently a trend towards performing tonsillectomy on a daycare basis and this study aims at evaluating how efficacious it may be in our setting.

Methods: A retrospective review of all the daycare tonsillectomy surgeries performed at the Pokhara ENT Center, Pokhara, Nepal from February 2018 to January 2019. Patients aged 15 years and up of either sex who met the paradise criteria were included while patients who met the same but had a contraindication for tonsillectomy surgery were excluded. Demographic information as well as complications within six hours of surgery before discharge and on follow-up on the seventh post-operative day were evaluated, as were any emergency room visits in the first 24 hours and any complications requiring a visit to a healthcare facility.

Results: On day of surgery 17% had worst pain and on seventh post-operative day 75% had no pain, only 2% presented with primary hemorrhage and 3% presented with secondary hemorrhage. None of them required revision surgery.

Conclusions: Daycare tonsillectomy is being done in only some of the centers owing to the risk of postoperative complications in our country. In our study, the number of complications was lower and not life-threatening. It can be considered a safe and cost-effective method, though patient selection is crucial.

Factors associated with final visual outcome in traumatic hyphema

Bishow Raj Timalsina — 2022-12-31

Introduction: Hyphema is the accumulation of blood in anterior chamber of the eye that can directly affect our vision. Various factors play role in final visual outcome among patients with hyphema, and there are very few related studies. Therefore, this study aimed to determine the factors related to final visual outcome among patients with traumatic hyphema.

Methods: This cross-sectional study was conducted among 62 cases of traumatic hyphema presenting to the emergency department of Tribhuwan University Teaching Hospital and outpatient department of Bisheshwar Prasad Koirala Lions Centre for Ophthalmic Studies from July 2018 to July 2019. A detailed clinical history was obtained, followed by an ophthalmic examination and relevant investigation. Data was analysed using descriptive and inferential statistics at 5% level of significance using IBM statistical package for the social sciences.

Results: Projectile (54.8%) and fall injury (12.5%) were the most common mode and causes of trauma, respectively. The best visual acuity of the involved eye at presentation was 6/9 (6.5%), and the worst was non-perception of light (3.2%). At presentation, the most common grade of hyphema was grade I (48.4%), and the least common was microhyphema (6.5%). Grades of hyphema (p=0.014) were significantly associated with the final visual outcome. Anterior segment findings such as of lid (p<0.001) and lens (p=0.014) and posterior segment findings such as of vitreous (p<0.001) and retina (p=0.048) were also significantly associated with final visual acuity.

Conclusions: For the most optimal visual outcome in traumatic hyphema, all associated periocular and intraocular findings must be prioritized and addressed accordingly.

Perception of faculties towards online teaching-learning activities during COVID-19 pandemic: A cross-sectional study at a tertiary care center in Eastern Nepal

Deependra Prasad Sarraf — 2022-12-31

Introduction: Online teaching learning activities is totally a new modality of medical education in the country with new opportunities, experiences and challenges. Objectives of the study were to explore the perception of faculties towards online teaching learning activities conducted during the COVID-19 pandemic and to find out barriers and facilitators to conducting online teaching learning activities in our context.

Methods: A web-based cross-sectional study was conducted among medical, dental, nursing and public health faculties using a semi-structured questionnaire. A Google Form was prepared and its link was sent to the faculties via email. Descriptive statistics were calculated using statistical package for the social sciences.

Results: Out of 158 faculties, 105(66.46%) were male and 121(85.44%) were medical faculties. Only 16(10.13%) faculties had received formal training regarding preparing and/or delivering online teaching learning activities. Out of 158, 133(84.18%) faculties faced technical and internet issues. The most common advantage and disadvantage of online teaching-learning activities perceived by the faculties were ‘not limited to time or place’ (149, 94.30%) and ‘lack of interaction with the students’ (130, 82.28%) respectively. Majority (149, 94.3%) of them had positive perception towards online teaching-learning activities conducted during COVID-19 pandemic. Slow internet connection (145, 91.77%) and frequent electricity interruption (131, 82.91%) were the most common perceived barriers to online teaching learning.

Conclusions: Most of the faculties had positive perception towards online teaching learning activities. Academic leaders and stakeholders should provide uninterrupted internet and electricity connectivity, training on online teaching-learning platform and timely technical support.

Shock Index in predicting fluid resuscitation in patients with hypovolemic shock

Manohar Pradhan — 2022-12-31

Introduction: Hypovolemic shock is diagnosed by the signs of hemodynamic instability and when the source of volume loss is obvious. Among various types, hypovolemic shock is the most common which results either from the loss of blood from hemorrhage or from the loss of plasma alone due to extravascular fluid sequestration or gastrointestinal, urinary, and insensible losses. The objective of this research was to find the use of shock index in predicting fluid resuscitation in patients with hypovolemic shock.

Methods: An analytical cross-sectional study was conducted among 120 patients with hypovolemic shock visiting to the Emergency department of College of Medical Sciences and Teaching Hospital from July 2022 to September 2022. Data was collected from patients and checked for completeness, accuracy and then entered and analyzed using SPSS-20. Data was analyzed using descriptive and inferential statistical tools. P-value <0.05 was considered as statistically significant.

Results: Out of 120 patients, majority of the patients were >50 years. Minority of the patients only required blood transfusion. Among total patients 60% of the patients were admitted in ICU, 25% of them were admitted in ward and 4.17% of them were expired. In 60% cases shock index was <1 while in 40% case shock index was ≥1. The number of patients receiving blood transfusion at ER increased with increase in shock index and that the number of patients with hypovolemic shock are admitted in hospital more in shock index category ≥1 as compared to shock index <1 (p-value <0.05).

Conclusions: This study reveals that shock index is accurate in predicting the amount of fluid. The risk of all clinical complication is increased with increase in shock index.

Comparison of collum angle and labial crown-root angle of maxillary central incisor in Class I and Class II division 2 malocclusion

Manju Pandey — 2022-12-31

Introduction: Variation in tooth morphology widely influences the achievement of optimum esthetics and stable occlusal relationship. This study was conducted to compare the collum angle and labial crown root angles in class I, class II division 2 malocclusions, using cephalometric radiographs, and to find a correlation between these angles.

Methods: This cross-sectional study was conducted from March 2018 to January 2021 among patients visiting the department of Orthodontics at Gandaki Medical College. A total of 62 lateral cephalograms were included and equally divided into 2 groups: Angle’s Class I and Class II division 2. Cephalometric tracing was done to measure the collum angle and labial crown root of maxillary central incisors. Pearson’s correlation test and independent t-test were used.

Results: There was a weak positive correlation (r=+0.348) between the angles in Class I group, (p=0.27) and a moderate positive correlation (r=+0.547) between the angles in Class II division 2 group (p<0.001). The mean collum angle was found to be greater in class II division 2 (11.90±6.86) than in class I (4.51±4.13) which was statistically significant (p<0.001). The mean labial crown root angle was found to be greater in class II division 2 (39.65±8.57) than in class I (30.23±5.20) which was statistically significant (p<0.001).

Conclusions: There was no statistically significant correlation between collum angle and labial crown-root angle in class I groups. The mean of collum angle and labial crown-root angle was found to be greater in class II division 2 which were statistically significant in both angles.

Detection of Salmonella carriers among apparently healthy cafeteria food handlers in tertiary care centre Pokhara

Sushil Kumar Chaudhary — 2022-12-31

Introduction: Foodborne illnesses are caused by consumption of contaminated foods. The risk of food getting contaminated depends largely on the health status of the food handlers, their personal hygiene, knowledge and practice of food hygiene. Hence, this study aimed to assess the proportion of Salmonella among food handlers working in the cafeteria of Gandaki Medical College Teaching Hospital, Pokhara, Nepal.

Methods: An institutional based cross-sectional analytical study was conducted from March 2018 to February 2019. A structured questionnaire was used to collect the sociodemographic characteristics, the knowledge and the risk factors of the participants. A total of 62 stool samples were collected and processed according to the standard microbiological procedures. All the Salmonella isolates were identified by biochemical tests. Additionally, antimicrobial susceptibility tests were performed according to Clinical and Laboratory Standards Institute guidelines 2017, using Kirby-Baur disk diffusion method. Data were analyzed by Statistical Package for Social Service for window version 21.0. Descriptive statistics were computed and chi-square test was applied at 5% level of significance. P-value <0.05 was considered to be statistically significant.

Results: Total of 62 food handlers were included in the study. Majority of the cafeteria workers 46(74.2%) were not aware of proper hand washing technique. Of the 62 food handlers working in the cafeteria, Salmonella were isolated from 12(19.4%) stool specimens. All the Salmonella isolates were sensitive to amikacin (100%), followed by imipenem (91.7%) and cefotaxime (91.7%). However, the highest rate of antibiotic resistance among Salmonella isolates was noted for amoxicillin (58.3%).

Conclusions: This study showed increased proportion of Salmonella carriers among the food handlers of cafeteria. Salmonella carriage among food handlers is of great concern as they can be the source of foodborne illness. Therefore, educating the food handlers of cafeteria about personnel hygiene may play a pivotal role in minimizing the incidence of foodborne illness and the associated morbidity

Knowledge on child rights among private and government school teachers, Pokhara, Kaski district

Indu Sah — 2022-12-31

Introduction: Children play vital role to the nation’s present and its future. The healthy and educated child of today is the intelligent and active citizen of tomorrow. Hence, the objective of our study was to assess the level of knowledge regarding child rights among teachers, compare the knowledge about child rights in context of private and government school, measure the association between knowledge regarding child rights with selected demographic variables.

Methods: This is a cross-sectional comparative study conducted among 200 school teachers 100 each from four government and three private schools of Pokhara using purposive sampling method. Data was collected from November 1 to December 1, 2021. Structured self-administered questionnaire tool on knowledge regarding child rights was prepared by the researcher herself. The data were collected by self-administered tool by researcher herself within 30 minutes. The quantitative data was analyzed using statistical package for social sciences version 20.0 descriptive statistics and non-parametric test were used for analyzing knowledge and association. P-value of <0.05 was regarded as significant.

Results: Private school teachers had high level of knowledge (68%) while government school teachers had comparatively lower knowledge level (61%) on child rights. There was statistically significant association between knowledge and education level among government school teachers. Sililarly, there was statistically significant association between knowledge and ethnicity, religion and information among private school teachers.

Conclusions: Private school teachers are more knowledgeable about child rights compared to government school teachers which emerges the need for further training to teachers.

Satisfaction with life among senior citizens in Pokhara metropolitan city: A cross-sectional study

Ranjita Karmacharya — 2022-12-31

Introduction: The number of senior citizens in the world is growing rapidly so life satisfaction is the best indicator for evaluating successful aging. The aim of the study was to assess life satisfaction among senior citizens in Pokhara metropolitan city.

Methods: This community-based cross-sectional study was conducted among 325 samples from 17 cluster of Pokhara metropolitan city. Life satisfaction were measured through life satisfaction index-A. Descriptive statistics and inferential statistics were computed at a 5% level of significance. Study participants were aged 60 years and above, residing permanently in the study sites. Wards, households, and respondents were selected randomly. Data were entered in Epi Data and analyzed using statistical package for the social sciences 16.0 version.

Results: Findings revealed that 53.5% respondents were not satisfied with their life. Likewise, age below 70 (52.4%), male respondents (53.7%), senior citizens (60+) living with partner (50.8%) were more satisfied. In multivariate analysis pension (OR=0.482, CI=0.248, 0.935), sufficient money for expenditure (OR=2.370, CI=1.362, 4.123), family income (OR=4.391, CI=2.019, 9.551), state of health (OR= 0.464, CI= 0.215, 0.923) and role in family decision making (OR=2.001, CI=1.055, 3.793) were positively associated with life satisfaction.

Conclusions: More than half of the senior citizens were dissatisfied with their life. Financial state, state of health and role in family decision making are the main determinant factors of life satisfaction. Therefore, the authority body needs to be developing proper old age policies to resolute the socioeconomic problems of old people.

Knowledge, attitude and practice towards COVID-19 among pregnant women in a tertiary hospital in Pokhara, Nepal

Benju Nepal — 2022-12-31

Introduction: The study was done to find out the knowledge, attitude, and practice of pregnant women towards COVID-19 in tertiary hospital of Pokhara, Nepal.

Methods: A descriptive cross-sectional study was carried out among 385 pregnant women attending antenatal clinics of Gandaki Medical College starting from May 2021 to July 2021, by using self- administered questionnaire. The data was analyzed using statistical package for the social sciences version 21.0 and descriptive statistics were computed.

Results: More than four‐fifths respondents were aware about COVID‐19. Half of them thought it transmits via human touch. One-fourth of them mentioned that delivery at the hospital during COVID-19 pandemic was unsafe. Almost half of them regretted conceiving, among which one quarter thought of aborting their fetus, half of them were against breastfeeding, and three-forth had regular antenatal care checkups. Majority of them took precautions to stay safe, where half of them responded that they would not breast fed baby if they got infected.

Conclusions: Majority of the study population have good knowledge, attitude, and practice of COVID-19 disease. However, it is worrisome that some respondents thought of terminating her pregnancy, and some were unable to visit the hospital for routine antenatal care checkups and didn’t have proper knowledge about breastfeeding their child. Proper education must be given to the population to avert these negative attitudes while promoting a positive preventive attitude.

Assessment of root and root canal morphology of mandibular premolars using cone beam computed tomography in a tertiary center of Nepal

Shikha Bantawa — 2022-12-31

Introduction: Mandibular premolars are considered an enigma in dentistry because of their variability in anatomical and morphological features making it difficult to treat endodontically. This study was conducted to determine the root and canal morphology of mandibular premolars in the Nepalese population by using cone beam computed tomography imaging.

Methods: One hundred and thirty-four cone beam computed tomography images of the Nepalese population were collected by convenience sampling method from April 1 to August 31, 2022 in Bir Hospital, Kathmandu, Nepal. A total of 536 premolars (268 mandibular first premolars and 268 mandibular second premolars) were evaluated by two examiners (one endodontist and one oral radiologist). Canal configuration was classified according to Vertucci’s classification.

Results: In mandibular premolar teeth, the majority had one root followed by two roots and fused roots. The most common configuration in mandibular premolars was Vertucci’s type I (83.88% and 96.65% in the first and second premolar respectively) followed by type V (9.89%) in the first premolar and type III (1.86%) in the second premolar. Vertucci’s type VII (0.37%), C-shaped configuration (1.46%), and an unusual configuration (0.37%) were observed in the first premolar. In mandibular first premolars, males showed more variation than females; while in second premolars, females showed more variation than males.

Conclusions: Mandibular premolar teeth showed variation in root and canal morphology with one root and Vertucci’s type I in the majority of the cases.

Clinico-epidemiological presentation of acute encephalitis syndrome in patients visiting a tertiary hospital in Kathmandu, Nepal: A descriptive cross-sectional study

Bidhi Dhital — 2022-12-31

Introduction: Acute encephalitis syndrome is diagnosed when a person of any age, and at any time of the year, presents with the acute onset of fever and a change in mental status and/or new onset of seizures. It has an ill-defined clinico-epidemiological presentation in Nepal, making it a challenging medical condition. The objective of this study was to study the clinical profile of acute encephalitis syndrome.

Methods: All consecutive admissions at Tribhuvan University Teaching Hospital between April 2017 and December 2018 were screened for acute encephalitis syndrome. The diagnosis was confirmed by history, examination, laboratory findings, brain imaging, and electroencephalography. All patients who met the inclusion criteria were enrolled. For data entry and analysis, statistical package for the social sciences software version 16.0 was used. Descriptive statistics as frequencies and mean ± standard deviations were computed.

Results: The mean age of the study population was 49.56±22.28 years with male predominance 42(58.3%). Among the diagnosed etiologies, 1.38% had Japanese encephalitis, 4.12% had herpes encephalitis, and 4.12% had autoimmune encephalitis. Out of the 72 patients, 52 patients (72.22%) had Glasgow coma scale >12, 15 patients (20.83%) had 8 to 12, and five patients (6.94%) had coma (Glasgow coma scale <8). Among the clinical findings, altered mental status (91.66%) was the most commonly noticed manifestation followed by fever.

Conclusions: Most patients had altered sensorium with less severe brain injury based on the Glasgow coma scale score during the presentation. Its low diagnostic yield, however, often leads to an increase in unknown etiologies. The syndrome was more prevalent in hilly regions.

The outcome of Transversus Abdominis Release for complex ventral hernia: A one-year of follow-up experience

Sagar Khatiwada — 2022-12-31

Introduction: Transversus Abdominis Release is a noble technique for the repair of complex ventral hernia, where the posterior component separation allows a huge pre-peritoneal space advantageous for the placement of large-sized mesh. It has less wound morbidity as compared to anterior component separation due to the preservation of skin perforators. The main objective of this study was to evaluate one-year follow-up results in terms of recurrence, wound morbidity, and various techniques for managing complications of Transversus Abdominis Release.

Methods: This is a descriptive crosssectional study that was conducted at the department of surgery, College of Medical Sciences Teaching Hospital. Among 41 patients with complex ventral hernia, 34 patients met the inclusion criteria. Demographic data, intra-operative events like bleeding, operative duration, intraoperative complications, post-operative events like duration of hospital stay, wound morbidity, and follow-up data were analyzed.

Results: Posterior rectus sheath closure at midline was possible in 30 (88.2%) patients. In patients, where posterior rectus sheath closure was not possible, the peritoneum of hernia sac was tailored to patch the defect or in some omentum was placed below the raw surface of mesh. The average operative duration and blood losses were 130±12 minutes and 301±133 ml respectively. The semilunar line injury occurred in one case that was diagnosed and repaired at the same time and the TAR plane was re-established. Wound morbidity occurred in three cases that were managed by dressing with commercially available collagen and mupirocin granule. No recurrence was observed in one-year follow-up.

Conclusions: Transversus Abdominis Release has a better result with no recurrence in short term follow up and fewer complications which are easily manageable.

Role of oral corticosteroids with adjunct to intravenous antibiotics in treatment of orbital cellulitis

Sangeeta Shah — 2022-12-31

Introduction: The standard treatment protocol of orbital cellulitis includes the use of broad-spectrum intravenous antibiotics. This study was done to evaluate the role of oral corticosteroids in the treatment of orbital cellulitis in order to address the inflammatory component.

Methods: A prospective comparative interventional study was carried out on 17 cases of orbital cellulitis over 16 months. All the patients were treated with intravenous antibiotics and were allotted to Group A or B. The former consisted of eight cases (intravenous antibiotics) while group B consisted of nine cases (intravenous antibiotics and oral corticosteroids). The oral corticosteroids were started after 24 to 48 hours of initiation of antibiotics. The outcomes compared between the two groups were hospital stay, visual analogue score, temperature, peri-orbital edema, proptosis, visual acuity, extra-ocular movement and conjunctival chemosis. Results: The age of the participants ranged from 7 to 77 years with M:F = 6:11. The mean duration of hospital stay was 7.75±2.7 and 8.22± 2.53 days in group A and B. The result showed that the changes in the other parameters were significant on the 3rd day after starting treatment in both groups but insignificant between the groups at the end of 7th and 14th day.

Conclusions: In our study, addition of oral corticosteroids to intravenous antibiotics showed no added beneficial effect over the use
of intravenous antibiotics alone in the treatment of orbital cellulitis. However, it was noted that there was no further
deterioration of the disease with the use of steroids.

Assessment of distribution of clinically undetectable mucogingival junction in mandibular anterior region: A single-institutional study

Soni Bista — 2022-12-31

Introduction: The mucogingival junction is considered one of the vital anatomic structures that mark the apical termination of the attached gingiva. However, due to various pathologies and conditions, it can be undetectable. This study aimed to assess the distribution of patients having teeth without clinically detectable mucogingival junction in mandibular anteriors. Various etiologies leading to clinically undetectable mucogingival junction were also identified.

Methods: This cross-sectional study involved 312 patients who visited the department of Periodontics of Gandaki Medical College Teaching Hospital and Research Center, Pokhara from July 26 to November 26, 2022. The visual method, rolling probe method, tension test and histochemical staining were used to detect the mucogingival junction. To ascertain the relationship between age and gender with the distribution of data, descriptive analysis and the Pearson Chi-square test was used. A p-value <0.05 was considered statistically significant.

Results: The majority of the patients 242(77.6%), had clinically detectable mucogingival junction, whereas the remaining 70(22.4%) didn’t show its absence. Gingival recession, keratosis, deep pockets, and aberrant frenal attachment were all common etiologic factors for clinically undetectable mucogingival junction. Statistically significant number of male patients from age group above 45 years presented with clinically undetectable mucogingival junction.

Conclusions: Nearly one-third of the study population presented with clinically undetectable mucogingival junction, which provides baseline data to determine the periodontal health of the study population and can represent as one of the significant diagnostic clues.

Multidrug resistant and extended spectrum β-lactamase producing gram negative bacterial uropathogens among females in a tertiary hospital, Pokhara

Raju Pandey — 2022-12-31

Introduction: Extended spectrum β-lactamase producing gram negative bacilli has emerged and spread worldwide as an important cause of urinary tract infections and indicates a major threat. The study aimed to determine the prevalence of multidrug resistant and extended spectrum beta-lactamase producing gram negative bacterial uropathogens among females in a tertiary level hospital.

Methods: A hospital-based cross-sectional study was conducted in Pokhara Academy of Health Sciences, Pokhara from February to November, 2019. A total number of 301 midstream urine samples were collected and examined using MacConkey agar and blood agar medium. Antimicrobial susceptibility testing was done by Kirby Bauer disk diffusion method on Mueller Hinton agar using Clinical and Laboratory Standards Institute guidelines.

Results: Out of 301 mid-stream urine samples, 99(33%) sample showed significant bacterial growth. Among them, 78(79%) were gram negative bacteria. Escherichia coli were the predominant organism. Multidrug resistant gram negative isolates were 65.4%. Among 78 Gram negative isolates, 31(39.7%) were extended spectrum β-lactamase producers. Among extended spectrum β-lactamase producers, 27(87.1%) were MDR. Highest frequency of extended spectrum β-lactamases production was seen in E. coli, 23(74.2%). Majority of gram negative bacteria showed susceptibility toward colistin and nitrofurantoin. Ampicillin was found to be highly resistant towards gram negative uropathogen.

Conclusions: This study found that higher proportion of multi-drug resistants were among gram negative isolates and further more among extended spectrum β-lactamase producing gram negative isolates. Thus, there is urgent need to address the issue of antimicrobial resistant and promote rational use of the antibiotics in our region.

Assessment of open surgical outcome of patients with lower limb varicose vein disease at a tertiary care center of Eastern Nepal

Bijay Sah — 2022-12-31

Introduction: The trend of varicose vein disease seems to be rising globally and its treatment options and outcome vary from the institution by institution. Management of the disease has also changed from high ligation, stripping, avulsion, and sclerotherapy to minimally invasive endovenous thermal ablation.

Methods: A retrospective observational study was carried out to find out the treatment methods and outcome of lower limb varicose vein disease at the cardiothoracic vascular surgery unit of the surgery department of B.P. Koirala Institute of Health Science from February 2019 to February 2020. The medical record of the patients was studied, relevant data entered and analyzed in statistical package for social sciences statistical software.

Results: Total registered patient during the study period were 46; which included 29(63%) male and 17(37%) female with mean age 38.41±10.12. Saphenous femoral junction reflux was seen in 38(82.60%) cases, saphenous popliteal junction reflux was seen in nine (19.60%) cases while perforator reflux was seen in 37(80.40%) cases. Saphenous femoral junction ligation, saphenous popliteal junction ligation was performed in 36(78.30%) and 7(15.20%) cases respectively. Stripping of the greater saphenous vein was done in 35(76.10%) cases, and 9(19.60%) cases were managed conservatively. Only 5(10.90%) cases developed infection, and none of the cases were found with recurrence or nerve injury. All the cases remained satisfied during the management course.

Conclusions: Saphenous femoral junction reflux was seen common and saphenous femoral junction ligation was performed on majority of the cases. Only 10% cases developed infection and all patients were satisfied during management course. Early surgical management of the disease overcomes complications and improves in the quality of life of the patients.