Journal of Nepalgunj Medical College <p>Official journal of the Nepalgunj Medical College and Teaching Hospital, Kohalpur, Nepal.</p> Nepalgunj Medical College and Hospital en-US Journal of Nepalgunj Medical College 2362-1192 <div class="results-preview"> <div><strong>Creative Commons License</strong></div> <div> </div> <div><a href="" rel="license"><img src="" alt="Creative Commons Licence" /></a><br />JNGMC is licensed under a <a href="" rel="license">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.</div> </div> <ul> <li>Attribution - You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any resonable manner, but not in any way that suggests the licensor endorses you or your use.</li> <li>Non Commercial- The materials cannot be used for commercial purposes.</li> <li>No Derivatives- If the material is remixed or transformed or built upon, the modified material cannot be distributed.</li> </ul> Seasonal Hyperacute Panuveitis (SHAPU) <p><strong>Introduction</strong><br />SHAPU is a mysterious disease seen and reported only from Nepal since 1975. It is an important cause of unilateralchildhood blindness and is the most devastating intraocular inflammatory disease leading to loss of sight within a week. Although initially presented as a case report at a Nepal prevention of blindness meeting in 1978 and reported in national journal Malla O, editor Endophthalmitis probably caused by Tussock moth. Report of the preceding of the first National seminar on Prevention of Blindness: 1978.Upadhyan MP: Eye problems of Nepalese Children in 1979.Now there are more than 10 published articles available in the Website.</p> Nanda Kumari Gurung Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 1 1 10.3126/jngmc.v19i2.42790 Distal Humeral Diaphyseal Open Fracture in a Child with Bone Loss <p>Distal diaphyseal humerus fracture is less common than supracondylar humeral fracture and its open fracture is even less. This is a case report of open distal humeral diaphyseal fracture on the left arm with bone loss in 10 years old male who sustained the injury from fall, diagnosed as Grade III open unstable distal diaphyseal shaft fracture of left humerus with bone loss without neurovascular deficit. We performed Open Reduction /Internal Fixation (OR/IF) and free bone fragment was flipped and fixed to the bone fragments and maximum possible contact was made and fixed with an external fixator. Range of motion was advised as early as possible. At final follow up the result was excellent as per Flynn's criteria. OR/IF (Open Reduction /Internal Fixation) of this fracture with posterior approach and flipping the bone to get more contact seems good and safe procedure. Further, external fixation provides reasonable fixation in these cases.</p> Sabin Shrestha Dinesh Kumar Shrestha Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 75 77 10.3126/jngmc.v19i2.43005 Unusual Case of Foreign Body Ingestion in a Child: A Case Report <p>Foreign body ingestion is a common problem in pediatric age group patients throughout the world. Radiographic findings revealed multiple foreign bodies throughout abdomen. Foreign objects attach frequently at the esophageal anatomic narrowing. They must be taken out immediately because they can cause an obstruction, mucosal erosion or perforation. Endoscopy is the criterion standard for removal of foreign bodies from the esophagus. Here, we report an interesting case of a multiple stones ingested by a female child. The child presented with complaints of distension of abdomen, vomiting and pain all over abdomen. The foreign bodies were found as hard black stones after removing them through anal route.</p> Suresh Kumar Nag Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 78 79 10.3126/jngmc.v19i2.43006 Prevalence and Characteristics of Gastrointestinal Symptoms and Hepatic Manifestation in Covid-19 Infection in Tertiary Care Center <p><strong>Introduction:</strong> Although the primary clinical manifestation of COVID-19 is pulmonary disease, but there are increasing data to support the gastrointestinal and hepatic involvement.</p> <p><strong>Aims:</strong> We aimed to see the prevalence and characteristics of gastrointestinal symptoms and hepatic manifestation in COVID-19 infection.</p> <p><strong>Methods: </strong>This is a hospital based descriptive cross-sectional study which was carried out in medicine department of Nepalgunj Medical College. Consecutive patients of COVID-19 cases confirmed by polymerase chain reaction were included. The presenting complaints, laboratory parameters, clinical events were noted. The primary objective was to determine the prevalence of gastrointestinal manifestation and hepatic dysfunction and their correlation with severity of pneumonia.</p> <p><strong>Results:</strong> Total patients enrolled in the study were 205. Majority of patients presented with respiratory symptoms 67.8%. Both respiratory and gastrointestinal symptoms were observed in 29.3% cases. Isolated gastrointestinal symptoms were observed in 2.9% cases. Common gastrointestinal symptoms were anorexia 14.1%, anorexia and nausea in 6.3%, pain abdomen in 3.9% and diarrhea in 2.4% cases. Hepatocellular type hepatic dysfunction reported in 53.2% cases. Rise in alanine aminotransferase (58.2% vs. 23.6%), aspartate aminotransferase (51.6% vs. 20.6%), alkaline phosphatase (44% vs. 15%), total bilirubin (76.6% vs12.5%) found significantly high in severe pneumonias compared with pneumonia only. Both gastrointestinal and hepatic dysfunctions were more common in severe cases (87.9% and 58.7%) than in mild disease (1% and 27%).</p> <p><strong>Conclusion</strong>: One third of the patients of COVID-19 can have gastrointestinal symptoms and hepatic dysfunction. Around 3% of patients presented with isolated gastrointestinal symptoms. Thus, unexplained gastrointestinal symptoms in contacts of COVID-19 may demand polymerase chain reaction test to confirm the disease. Both gastrointestinal and hepatic dysfunction was more prevalent in severe pneumonia.</p> Dipendra Khadka Sudhamshu KC Kiran Regmi Binus Bhandari Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 2 6 10.3126/jngmc.v19i2.42791 Single Layer versus Double Layer Technique for Intestinal Anastomosis: A Comparative Study <p><strong>Introduction:</strong> Intestinal anastomosis is a surgical procedure executed to ascertain communication between two segments of the intestine, after the removal of pathology affecting the bowel. It depends on factors like anastomosis site, bowel capability and the type of the pathogenesis.</p> <p><strong>Aims:</strong> To compare single versus double layer method in terms of time taken for anastomosis, hospital stay, post-operative leak and cost effectiveness.</p> <p><strong>Methods:</strong> This is a comparative hospital based study carried out at the department of surgery Nepalgunj Medical College from September 2017 to August 2020. Patients requiring emergency laparotomy with resection and anastomosis of small bowel were included. Patients requiring colonic anastomosis, diversion stoma and multiple anastomoses were excluded. Patients were divided in to two groups- single layer and double layer group. Each group was compared for outcome measures like time taken to construct the anastomosis, hospital stay, post-operative leak and cost of surgery.</p> <p><strong>Results: </strong>The total number of patients was 50. The mean age was 45.57±17.42 years for single layer and 48.67±18.16 years for double layer group. Time taken for intestinal anostomosis in single and double layer were 18.28±5.08 and 25.27±6.18 respectively which was statistically significant (p - &lt;0.012). Hospital stay was 10.9±1.43 in single layer and 11.2±1.87 which was statistically not significant (p - &gt;0.342). Similarly, the anastomosis leak was seen in 2 patients in single layer and 3 in double layer. Which was statistically not significant (p - &gt;0.318). While comparing the cost effectiveness single layer technique was cost effective.</p> <p><strong>Conclusion</strong>: The single layer anastomosis is a preferable, safe and economic technique in comparison to the conventional double layered anastomosis.</p> Bimarsh Adhikari Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 7 10 10.3126/jngmc.v19i2.42792 Forgotten Double-J Stent – An Extra Burden to both Patient and Urosurgeon: A Single Center Experience <p><strong>Introduction</strong>: Double-J stent is widely used in urological as well in few non urological operations, which must be removed or replace timely. Otherwise unnecessary complications can be encountered. Forgotten Double-J stent is one of them.</p> <p><strong>Aims:</strong> To find out the cause of forgotten Double-J stent, its complications and prevention.</p> <p><strong>Methods</strong>: It is a hospital based study done from 2017-2020 in Nepalgunj Medical College. 33 patients fulfilling the inclusion criteria were included and reviewed for the cause, complications and management of forgotten Double-J stent.</p> <p><strong>Results</strong>: Out of 33 patients, 25 (75.75 %) were operated at Nepalgunj Medical College and 8(24.24%) were in other hospitals. Among them, major causes of forgotten Double- J stent were found due to Poor financial condition and ignorance 10(30.30%) and remote inhabitant 10(30.30%). Major symptoms were flank painalone in 10(30.30 %) and recurrent fever with flank pain with positive urine culture in 8(24.24%). 21 patients (63.63%) required additional surgical treatment such as percutaneous nephrolithotripsy, ureterorenoscopic lithotripsy, percutaneous cystolithotripsy, perurethtalcystolithotripsy, open cystolithotomy.</p> <p><strong>Conclusion:</strong> Forgotten Double-J stent is one of the major complications if not removed timely which may increases morbidity, mortality and financial burden. The rate of it may minimize if patients are made aware for the complications of Double-J stent and maintain stent registry properly.</p> Naresh Man Shrestha Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 11 14 10.3126/jngmc.v19i2.42793 Oral Squamous Cell Cancer Scenario in a Tertiary Hospital in Western Region of Nepal <p><strong>Introduction</strong>: Oral squamous cell cancer involves oral subsites namely lip, buccal mucosa, gingivobuccal sulcus, mandible, retromolar trigone, tongue, floor of the mouth, maxilla and hard palate. It has multifactorial etiologies. Alcohol, tobacco chewing, smoking, betel quid chewing, trauma and HPV viruses are implicated as the predisposing factors of oral squamous cell carcinoma. If detected early, oral cavity cancer is easily preventable and curable.</p> <p><strong>Aims:</strong> To evaluate oral squamous cell cancer demographics, as well as risk factors, site, grades, and stages.</p> <p><strong>Methods</strong>: This prospective cross-sectional descriptive type of study was done in patients attending dental outdoor patient department of Nepalgunj medical college from July 2018 to August 2020. 46 patients selected by enumerative sampling method in the study after they were histopathologically confirmed with oral squamous cell carcinoma by biopsy. All included patients were having primary oral cancer, single, unilateral and untreated. After data collection current oral squamous cell cancer demographics, as well as risk factors, site, grades, and stages were established.</p> <p><strong>Results:</strong> Out of 46 patients ranging from 32 to 79 years 28(60.8%) were males and 18(39.1%) were females with mean age range of 55.41 ± 10.84 years. 26(56.5%) of total displayed oral squamous cell carcinoma at buccal mucosa. 25(54.3%) of total consumed gutkha and paan with betel nut plus tobacco. 30(65.2%) of total were exposed to carcinogen for a period of 21-40 years. 32(69.5%) of total had well differentiated oral squamous cancer. 32(69.5%) of total were at stage III at the time of presentation.</p> <p><strong>Conclusion</strong>: Oral cancer occurred more in males, at buccal mucosa and in people above 51 years, and in those who consumed gutka and paan, betel nut plus tobacco. It was also more in people with longer history of exposure to carcinogens.</p> Dwarika Prasad Bajgai Bela Agrawal Narayan Sharma Lamichhane Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 15 18 10.3126/jngmc.v19i2.42848 Evaluation of Bacterial Co-infections of the Respiratory Tract in COVID-19 Patients <p><strong>Introduction:</strong> The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2. The co-evolution of viral and bacterial respiratory pathogens has created an environment in which a viral infection allows concurrent or secondary bacterial co-infections.</p> <p><strong>Aims:</strong> This study was carried out to isolate the different respiratory bacterial pathogens from COVID patients and evaluate their antibiotic sensitivity pattern.</p> <p><strong>Methods:</strong> Hospital based descriptive cross sectional study was conducted over a period of between 2<sup>nd</sup> Jestha to 5<sup>th</sup> Shrawan 2078 (16<sup>th</sup> May to 20<sup>th</sup> July 2021) in Nepalgunj Medical college, Kohalpur during the second wave of COVID-19 in Nepal. The sputum was inoculated onto different culture plates such as Blood Agar (BA) and MacConkey Agar (MA) and incubated at 37 <sup>o</sup>C. After overnight growth and in Gram staining, different Gram’s positive and negative bacteria were observed. Antibiotic sensitivity test was performed by Kirby-Bauer Disk Diffusion method.</p> <p><strong>Results:</strong> Out of 100 sputum samples, 44% positive bacterial growths, majority isolates were Klebsiella spp and Staphylococcus aureus. Overall, the pathogens were mostly sensitive to meropenem followed by colistin, piperacilin/tazobactam respectively.</p> <p><strong>Conclusion:</strong> Bacterial co-infection is common in hospitalized patients with SARS-CoV-2.</p> Kishor Gurung Prabesh Pant Sandeep Pokhrel Dhan Raj Neupane Samjhana Gurung Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 19 22 10.3126/jngmc.v19i2.42851 Comparative Study between Conservative Management and Appendectomy in Appendicular Lump in Children <p><strong>Introduction:</strong> Acute appendicitis is the most common presentation in the pediatric emergency department. Presentation ranges from mild inflammation to perforation and peritonitis. Frequently, patients present late with lump formation. Traditionally, an appendicular lump is managed conservatively followed by interval appendectomy six weeks later when the inflammation has resolved.</p> <p><strong>Aims:</strong> This study was designed to evaluate the outcome of early appendectomy in cases of appendicular lump and their complications compared to the conventional method of conservative management followed by interval appendectomy.</p> <p><strong>Methods:</strong> A prospective comparative study was conducted between November 2018 and October 2021. All the patients with appendicular lump of up to 7 days duration diagnosed clinically or by ultrasonography were randomly divided into two groups. Group I patients were conservatively managed as per the Ochsner-Sherren regimen. Patients in Group II were operated within 24 hours of admission. Mean operative time was recorded in each case. Complications following the respective interventions were observed.</p> <p><strong>Results:</strong> Sixty-two patients of which 42 males and 20 females were diagnosed to have an appendicular lump. The age of the patients ranged from seven to 15 years. Duration of onset ranged from three to seven days at the time of presentation in the emergency room. All the patients in Group I except two patients underwent conservative management. There were four readmissions among Group I patients and one in Group II. The average operating time was 67 minutes for patients undergoing open appendectomy. Complications following surgery were more in patients presenting with history of over five days duration. Group I patients had a comparatively greater number of hospital admission days compared to Group II (7.1 and 4.8 days).</p> <p><strong>Conclusion:</strong> The appendicular lump can be explored early as it confirms the diagnosis, shortens the financial burden and hospital stay and avoids follow-up visits for interval surgery.</p> Feeroz Alam Khan Nabin Paudel Prabir Maharjan Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 23 26 10.3126/jngmc.v19i2.42859 Trial without Catheter in Acute Retention of Urine secondary to Prostatomegaly <p><strong>Introduction:</strong> Acute Retention of Urine is one of the main presentations for Benign Prostatic hyperplasia. Trial without catheter is an ambulatory care protocol. The greater morbidity and mortality associated with emergency surgery, and the potential morbidity associated with prolonged catheterization have led to the increasing use of a trial without catheter. Trial without catheter involves catheter removal allowing patients to void successfully so that surgery can be performed at a later stage. Use of an alpha (1)-blocker before a Trial without catheter has demonstrated that it increases its success.</p> <p><strong>Aims:</strong> Identifying the success and failure of Trial without Catheter in patients with Benign Prostatic Hyperplasia and evaluating factors influencing them.</p> <p><strong>Methods</strong>: A total of 60 patients who presented with acute urinary retention were enrolled in this study at Nepalgunj Medical College which was conducted between February 2021 and August 2021. All the patients underwent Foley Catheterization. Tablet Alfuzosin 10mg one tablet at night and requested follow-up after a week. Trial without Catheter conducted and the amount of urine measured after removal of the Foley catheter.</p> <p><strong>Results:</strong> The study evaluated various factors predicting success of Trail without Catheter. Age group of 61-70years had higher success. Patients with moderate American Urological Association score had higher success rates than the rest. About 10 (6%) patients had a Quality of Life of less than four. The prostate volume ranging from 30-39ml had higher success rates. Patients with Grade III Intravesical Prostatic Protrusion had fewer chances of successful Trial without Catheter. Duration of Lower Urinary Tract Symptoms less than six months was favorable for the success of Trial without Catheter. Thirty five (58.3%) patients voided more than 200ml during Trial without Catheter.</p> <p><strong>Conclusion:</strong> Trial without catheter should be opted for selective patients having Benign Prostatic Hyperplasia presenting with Acute Urinary Retention.</p> Digbijay Bikram Khadka Anup Sharma Prabir Maharjan Copyright (c) 2022 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 27 31 10.3126/jngmc.v19i2.42860 Stretching Exercise versus Local Corticosteroid Injection in Plantar Fasciitis: A Comparative Study <p><strong>Introduction:</strong> Plantar fasciitis is an inflammatory painful condition, one of the most common causes of heel pain. The cause of it is multifactorial; and different treatment modalities are available.</p> <p><strong>Aims:</strong>To compare the effectiveness between the stretching exercise and corticosteroid injection.</p> <p><strong>Methods</strong>:This study was conducted at Nepalgunj medical college, in the department of orthopedics from September 2019 to September 2020. Patients were equally divided into two groups. In Group A corticosteroid injection was given and in group B stretching exercise was advised. Patients were followed up at two weeks, 8weeks and 16weeks; pretreatment and post-treatment pain level was assessed by Visual Analog Scale (VAS) and Functional outcome was assessed by Foot and Ankle Ability Measure (FAAM) Scale.</p> <p><strong>Results:</strong> Both groups were comparable in relation to age and sex. There was significant decrease in pain and improvement of function in steroid group at two weeks and eight weeks follow up; whereas at 16weeks follow up plantar fascia stretching groups improved significantly.</p> <p><strong>Conclusion:</strong> For short term relief local corticosteroid injection is superior; but for long term relief in pain and improvement in function plantar fascia stretching exercise is better treatment option.</p> Sandeep Gurung Gopal Sagar DC Biswas Pant Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 32 35 10.3126/jngmc.v19i2.42861 Outcome of Management of Pediatric Subtrochanteric Femoral Fracture with Broad Dynamic Compression Plate and Proximal Cancellous Screw through the Femoral Neck <p><strong>Introduction:</strong> Pediatric subtrochanteric femoral fracture can be managed with traction followed by spica, intramedullary elastic nailing, plating or external fixators. The prognosis largely depends on adequate reduction and stable fixation.</p> <p><strong>Aims:</strong>The aim of this study was to evaluate functional outcome of pediatric subtrochanteric femoral fracture treated with broad dynamic compression plate.</p> <p><strong>Methods:</strong> This prospective observational study consisted of 32 children between the age 7 to 15 years, with an average of 10.06 years ± 2.29, with subtrochanteric femoral fracture. Fractures were reduced by an open reduction through lateral approach and stabilized with a broad dynamic compression plate along with a proximal cancellous screw through the femoral neck. All patients were followed for 15 months and the results were evaluated on the basis of Flynn scoring system.</p> <p><strong>Results:</strong> All fractures united with a mean duration of 12.6 weeks ± 0.91. Average hospital stay was 8.43 days (5 to 14 days). Functional outcome was excellent in 84.38% (27 patients) and satisfactory in 15.62% (5 patients). Full weight bearing was started after mean duration of 16.62 weeks ± 0.91. Implants were removed at an average of 11.21 months ± 1.06. There were no significant limb length discrepancies, deep infections, re-fracture, osteomyelitis and avascular necrosis.</p> <p><strong>Conclusion:</strong> This prospective study showed good functional outcome in pediatric patients having subtrochanteric femoral fractures who were treated with a broad dynamic compression plate and a proximal cancellous screw through neck.</p> Prateek Karki Dinesh Kumar Shrestha Roshani Ranabhat Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 36 39 10.3126/jngmc.v19i2.42987 Perinatal Outcome in Term Pregnancy with Isolated Oligohydramnios: Retrospective Observational Study <p><strong>Introduction:</strong> Isolated Oligohydramnios complicates 3 to 5% of pregnancy at term both in terms of fetal outcome and mode of delivery.</p> <p><strong>Aims:</strong> To study the perinatal outcome in isolated oligohydramnios (Amniotic Fluid Index≤8) and compare the outcome between Borderline (Amniotic Fluid Index=5.1-8 cm) and Severe (&lt;5 cm) oligohydramnios.</p> <p><strong>Methods:</strong> Retrospective observational study of pregnancy outcome with isolated oligohydramnios (Amniotic Fluid Index≤8 cm) at term was carried out in Gandaki Medical College Teaching Hospital, Pokhara for one year from January 2019 to December 2019. Patients were divided into Borderline Oligohydramnios (Amniotic Fluid Index=5.1 to 8 cm) and Severe Oligohydramnios (Amniotic Fluid Index ≤5 cm). The two groups were compared in terms of fetal outcome like: meconium passage, low birth weight, low APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score at 1 and 5 min, Neonatal Intensive Care Unit (NICU) admission and neonatal death. Similarly mode of delivery was also compared.</p> <p><strong>Results</strong>: There were total of 100 patients with isolated oligohydramnios. Of which 51(51%) were with Borderline Oligohydramnios and 49(49%) with Severe Oligohydramnios. The incidence of adverse perinatal outcome and caesarean delivery was high in patients with isolated oligohydramnios. When compared with the two groups there was significant difference in terms of meconium passage (11% vs 48.9%), low birth weight (5.8% vs 18%), low APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score at 1 min (1.9% vs 14%), NICU (Neonatal Intensive Care Unit) admission (11% vs 67%) and Caesarean delivery (39% vs 79.5%).</p> <p><strong>Conclusion</strong>: Isolated oligohydramnios at term has been associated with an increased risk for caesarean delivery for fetal distress and adverse perinatal outcomes. Severe oligohydramnios is a sensitive predictor for the adverse perinatal outcome both in terms of fetal outcome and termination of pregnancy.</p> Ayushma Adhikari Tika Kumari Gurung Shree Prasad Adhikari Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 40 42 10.3126/jngmc.v19i2.42989 Comparative Study of Minimally Invasive Percutaneous Plate Osteosynthesis versus Reamed Intramedullary Nail Fixation for Extra Articular Distal Third Tibial Fractures <p><strong>Introduction:</strong> Extraarticular distal third tibial fractures are highly controversial and difficult to treat despite of numerous methods of fixation. The most common methods of treating these fractures are minimally invasive percutaneous plate osteosynthesis (MIPPO) and reamed intramedullary nailing (RIMN).</p> <p><strong>Aims:</strong> The aim of this study is to compare and assess its demographic status, preoperative status and functional outcomes of these two groups of patients with extraarticular distal third tibial fractures.</p> <p><strong>Methods:</strong>This prospective hospital based observational study of 36 patients with extra articular distal third tibial fractures was carried out from January 2018 to January 2021 at Nepalgunj Medical College Teaching Hospital, Kohalpur. Thirty-six patients were included in the study and were divided into two groups of 18 each and were treated with MIPPO and RIMN methods and were followed up regularly. Clinical and functional outcome were evaluated at 12 months.</p> <p><strong>Results:</strong> Out of 36 patients 20 were male and 16 were female. Mean age was 37.63with SD ± 11.43 years. Twenty two were right sided and 14 were left sided. Mean duration of surgery in MIPPO group was 75.33 with SD ± 14.64minutes and in RIMN group was 98.33with SD ± 18.96 minutes. There were 24 cases of associated fibular fractures. Two cases of surgical site infection and two cases of K-wire impingement on fibular side were encountered in MIPPO group whereas three cases of postoperative blisters were seen in RIMN group. All fractures united. The mean average time for fracture healing in MIPPO group was 25.55 weeks and in RIMN group was 27.55 weeks. The clinical and functional outcome were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) scoring system, the mean score in MIPPO group was 91.22 and in RIMN group was 90.77.</p> <p><strong>Conclusion:</strong> There was a good outcome in MIPPO group than RIMN group for extra articular distal third tibial fractures.</p> Dinesh Kumar Shrestha Dipendra KC Prateek Karki Sabin Shrestha Sushil Yogi Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 43 47 10.3126/jngmc.v19i2.42991 Trends in Bloodstream Infection in Tertiary Care Hospital: A Retrospective Cross-sectional Study <p><strong>Introduction:</strong> Bloodstream Infection is one of the leading causes of mortality and morbidity among various groups of patients in a developing country like Nepal. Identification of the bacteria and their susceptibility to commonly used antibiotics is very essential for the treatment of the patients.</p> <p><strong>Aims:</strong> This study aims to analyze current trends in bloodstream infection by accessing their bacteriological profile and antibiotic susceptibility.</p> <p><strong>Methods:</strong> This is a hospital-based retrospective analysis of blood cultures of patients suspected with bloodstream infection. We conducted a three years (January 2018 to January 2021) retrospective analysis of blood culture reports from patients suspected with bloodstream infection. Data of the laboratory reports were used to determine bloodstream infection, blood culture contamination, pathogen profile and antimicrobial resistance patterns.</p> <p><strong>Results:</strong> Out of 12811 blood samples that were sent to microbiology laboratory for culture, 438 were positive cultures. The most common etiological agent causing Bloodstream Infection was found to be Salmonella Typhi with129 isolates (29.6%) followed by Escherichia coli (21.9%). There was a significant rise in resistance to most of the frequently used antibiotics.</p> <p><strong>Conclusion:</strong> Salmonella Typhi is the most frequent bacteria to be isolated in Bloodstream Infection. Resistance towards different etiological agents of Bloodstream Infection is alarmingly increasing every year. Resistance to frequently prescribed drugs should be of concern to the clinicians prescribing the drugs.</p> Srijana Ranjit Nishan Katuwal Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 48 52 10.3126/jngmc.v19i2.42992 Outcome of Pediatric Humerus Fracture Treated With Close Reduction and Elastic Intramedullary Nailing <p><strong>Introduction:</strong> Pediatric humeral shaft fractures are infrequent fractures only secondary to trauma or any of the pathological changes in the bone; representing two to 5.5% of all pediatric fractures and occurring predominantly in children younger than three years or older than 12 years of age. These fractures can usually be treated conservatively with functional bracing and splints however conditions like inability to maintain an acceptable reduction, open fractures, floating elbow, closed head injury, and polytrauma patient requiring early weight bearing warrant the surgical intervention. The intramedullary elastic nails have been found to be more effective in treating fracture shaft of humerus of pediatric age group in comparison over other implants used.</p> <p><strong>Aims:</strong>The aim of this cross-sectional observational study was to evaluate the outcome of shaft of humerus fracture in children treated with retrograde intramedullary kirschner’s wire.</p> <p><strong>Methods:</strong> This prospective study was conducted in the department of Orthopedics in Nepalgunj Medical College Teaching, Kohalpur from January 2020 to March 2021 in 26 children. Children were evaluated for age, sex, side of injury, mechanism of injury, time period for union, implant removal time, outcome and accompanying complications. Patients were evaluated using Broberg and Morrey scoring system for elbow functions and modified Dash criteria for shoulder function.</p> <p><strong>Results:</strong> In this study of 26 children, 65.4% were boys and 34.6% were girls with average age of 9.58 ± 2.1 years. Left side was prominent side for injury with 69.2%. The average duration for union was found to be 10.04 ± 1.42 weeks. The implant was removed at 24.19 ±1.57 weeks. Based on Broberg and Morrey score system for elbow, 23 (88.46%) children had excellent result and three (11.54%) had good result. While evaluating for Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder joint evaluation; all children had excellent result.</p> <p><strong>Conclusion:</strong> The treatment of pediatric humeral shaft fracture by close reduction and intramedullary kirschner’s wire is safe, easy and cost effective operative procedure with good results.</p> Sushil Yogi Dinesh Kumar Shrestha Dipendra KC Prateek Karki Sabin Shrestha Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 53 56 10.3126/jngmc.v19i2.42993 Correlation between McIssac Score and Throat Swab Culture in Patient Presenting with Acute Tonsillitis <p><strong>Introduction:</strong> Tonsillitis is inflammation of tonsils which is characterized by various signs and symptoms with sore throat being the most consistent symptom. The condition is mostly caused by bacterial infection with Streptococci being the most common bacteria. McIssac scoring technique is clinical symptoms based scoring method designed for diagnosing streptococcal tonsillitis.</p> <p><strong>Aims:</strong> To find out the association between McIssac Score and beta hemolytic streptococcal infection in acute tonsillitis.</p> <p><strong>Methods:</strong> This hospital based, prospective study was carried out in the Department of ENT, Nepalgunj Medical College from July 2020 to June 2021. Patients were scored as per McIssac score. The specimens were collected from the tonsillar surface using sterile cotton swabs and subjected for culture and sensitivity.</p> <p><strong>Results:</strong>The most common affected age group was 21 to 30 years (46%). Females were affected more commonly (57%). The most common organism isolated in the study was Group A beta hemolyticn Streptococcus (48%), followed by Pseudomonas (10%), Enterococcus (9%) and Klebsiella (8%) and no organisms were isolated in 25% of the patients. It was observed that high McIssac score was associated with higher chance of having positive beta hemolytic streptococcal infection. Out of 48 group A beta hemolytic streptococci culture positive patients 18(37.5%) patients scored 3, 9 (18.75%) patients scored 4 and 7(14.5%) patients scored 5.The most common antibiotic effective against group A beta hemolytic srtreptococci was ceftriaxone in 25(72.9%), followed by amoxyclavulinic acid in 20 isolates (41.6%) and amikacin in seventeen (35.4%) isolates.</p> <p><strong>Conclusion:</strong> The correlation between throat swab culture and McIssac score emphasized that this clinical scoring system aid in early diagnosis of group A beta hemolytic streptococci tonsillitis.</p> Shama Bhandari Dhundi Raj Paudel Kishor Gurung Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 57 60 10.3126/jngmc.v19i2.42994 Effectiveness of Modified Tension Band Wiring for Medial Mallelous Fracture of Tibia <p><strong>Introduction:</strong> Medial malleolus fracture is one of the commonest fractures. Non-operative approach may fail to produce anatomical reduction leading to ankle instability, nonunion and post traumatic osteoarthritis of the ankle. Proper anatomical reduction and stable internal fixation remains the key in treatment of displaced fracture. Good result had been achieved with Modified Tension Band Wiring.</p> <p><strong>Aims:</strong>The purpose of our study was to evaluate the functional outcome of medial malleolus fracture treated with modified tension band wiring.</p> <p><strong>Methods:</strong>This prospective observational study was conducted in department of Orthopaedics of Nepalgunj Medical College and Teaching Hospital from September 2018 to August 2021. Patients were evaluated for mode of injury, type of fracture, associated injury, radiological union, functional outcome, accompanying complications. All of the medial malleolus fractures in this study were treated by modified tension band wiring and outcomes were evaluated using Olerud and Molander Score.</p> <p><strong>Results:</strong> In this study of 40 patients with the mean age of 41.60+13.75 year, 31(77.5%) were male and 9 (22.5%) were female. Majority of fractures were observed between 35 to 44 years, right side was predominantly involved, road traffic accident was the most common mode of injury. The average time duration of surgery from the time of injury was 5.25 days. Final functional outcome as per Olerud and Molander score showed, seven (17.5%) patients had excellent results, 30 (75%) patients had good results and three (7.5%) patients had poor results. The most common complication noted was hardware prominence at 7.5%, followed by superficial wound infection in 5% of patients.</p> <p><strong>Conclusion:</strong> Modified Tension band wiring of medial malleolus results in good to excellent outcome in most of the patients with few complications .</p> Dipendra KC Dinesh Kumar Shrestha Prateek Karki Sushil Yogi Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 61 65 10.3126/jngmc.v19i2.42998 Risk Factors Associated with Urinary Tract Infection in Children <p><strong>Introduction:</strong> Urinary tract infection is infection leading to an inflammatory response in the epithelium of the urinary tract. Urinary tract infection is defined as the growth of significant number of organisms of a single species in the urine, in the presence of symptoms. Significant bacteriuria is a growth with colony count of &gt;105 / ml of a single species in a mid-stream clean catch urine sample.</p> <p><strong>Aims:</strong> To find the prevalence of urinary tract infection in children with fever and its risk factor.</p> <p><strong>Methods:</strong> A hospital based cross sectional observational study was performed in Nepalgunj Medical College, Kohalpur from October 2019 to October 2020.Children of age two months to 14 years admitted in Department of Pediatrics and visiting in outdoor fulfilling inclusion criteria were taken for the study. Detailed history and examination was performed. Data related to age, sex, predisposing risk factors of Urinary tract infection, symptoms and relevant investigations was carried out in all patients.</p> <p><strong>Results:</strong> Among 135 children, maximum 62(45.92%) children were in the age group 1-5 years. There were 70(51.85) male and 65(48.14) female children. The prevalence of culture positive of urinary tract infection was 19.20%. Pyuria was more significant in females in comparison to male, more common in age group less than 5 years. 26 children were culture positive among which males to female ratio in urine culture positive cases were 1: 2.3 and majority had E.coli positive in urine culture sample. Apart from the female children urinary tract infection was commonly seen in uncircumcised male comprising of 8(11.42%) of total male children.</p> <p><strong>Conclusion:</strong> In children presenting with fever, urinary tract infection was one of the common causes. It was most common in children less than 5 years, female gender and uncircumcised male children were two commonly associated risk factors</p> Murli Manohar Gupta Suman Ram Shrestha Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 66 70 10.3126/jngmc.v19i2.43000 Morphological Variations and Morphometric Analysis of the Caudate Lobe of Liver: A Cadaveric Study <p><strong>Introduction:</strong> The caudate lobe is most referred area of the liver radiologically. In cirrhosis, the right lobe exhibits relatively greater shrinkage, while the caudate lobe undergoes relative enlargement as it is the only segment which receives blood independently from left and right branches of portal veins.</p> <p><strong>Aims:</strong> To assess the morphological variations and morphometric analysis of the caudate lobe of liver in the cadavers.</p> <p><strong>Methods:</strong> This was a cross-sectional descriptive study conducted on 48 formalin fixed human liver specimens available in the gross anatomy laboratory of Department of Anatomy, National Medical College, Birgunj, Nepal. The caudate lobe of liver specimens was studied for morphological variations and different measurements were taken, and the result was presented in tables.</p> <p><strong>Results:</strong> The caudate lobe showed a wide range of variations in shape. Caudate lobe was present in all 48 specimens of liver out of which, 15 specimens were rectangular (31.25%), 26 specimens were pyriform (54.16%) and 7 specimens were irregular (14.58%) respectively. In 6 liver specimens (12.50% of total number of liver specimens), there was vertical fissure that extended upwards from the lower border of caudate lobe was seen in 6 specimens (12.50%). Notch was present in 10 specimens (20.83%).</p> <p><strong>Conclusion:</strong> The caudate lobe of the liver showed a great degree of variations and the most common shape was pyriform. The ratio of the transverse diameter of the caudate lobe to that of the right lobe of the liver (CT/RL) ratio was found to be 0.14.</p> Ram Jiban Prasad Kapil Amgain Tirtha Narayan Shah Copyright (c) 2021 Journal of Nepalgunj Medical College 2021-12-31 2021-12-31 19 2 71 74 10.3126/jngmc.v19i2.43004