Journal of Nepalgunj Medical College https://www.nepjol.info/index.php/JNGMC <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 All the scientific materials included in this journal are the copyright of Nepalgunj Medical College (NGMC). No part of this publication is to be reproduced in any form without prior written permission of the Editor. Medical Education during COVID-19 Crisis: Challenges and Opportunities https://www.nepjol.info/index.php/JNGMC/article/view/34716 <p>Not available.</p> MN Marhatta Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 1 2 10.3126/jngmc.v18i1.34716 Caesarean Section in Confirmed COVID-19 Patient at Nepalgunj Medical College: Case Report https://www.nepjol.info/index.php/JNGMC/article/view/35222 <p>An outbreak of novel coronavirus pneumonia occurred worldwide since December 2019, which had been named COVID-19 subsequently. It is extremely transmissive that infection in pregnant women were unavoidable. The delivery process will produce large amount of contaminated media, leaving a challenge for medical personnel to ensure both the safety of the mother and infant and good self-protection. Here, we report a 27 year woman had reverse transcription polymerase chain reaction-confirmed COVID-19 at 37 weeks 2 days of gestation. An emergency caesarean section at 38 weeks 2 days of gestation under spinal anaesthesia was performed for oligohydramnios with scar tenderness with strict protection for all personnel.</p> Kavita Sinha Amrendra Kushwaha Homnath Adhikari Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 105 106 10.3126/jngmc.v18i1.35222 Bilateral Blindness Due to Left Fronto-Temporal Lobe Glioblastoma Multiforme https://www.nepjol.info/index.php/JNGMC/article/view/35224 <p><strong>Introduction: </strong>Glioblastoma multiforme is the most common primary malignant brain tumor, with a very poor prognosis. Direct compression of any structure in the visual pathway or chronic papilloedema is the cause of loss of vision in these patients.</p> <p><strong>Case Report:</strong>&nbsp; 30 years old male from Dailekh was brought by his elder brother with the complaint of complete vision loss in both eyes for 45 days. He also had hearing difficulty on right side, headache, right sided weakness and abnormal body movement. His Visual acuity was no perception of Light in both eyes. Pupil was mid-dilated and not reacting to light. Fundus examination revealed bilateral Pallid disc edema. MRI brain revealed left fronto-temporal GBM compressing optic chiasm. Neurosurgical consultation was obtained and counseling was done regarding disease and its treatment. Due to poor prognosis and poverty patient choose palliative conservative treatment.</p> <p><strong>Conclusion</strong>:&nbsp; This case highlights the possibility of bilateral Blindness in unilateral GBM. GBM has very poor outcome even after treatment.</p> Bikram Bahadur Thapa Joshan Neupane Sunil Moktan Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 107 110 10.3126/jngmc.v18i1.35224 Clinical Spectrum- Cognition, Stages, Functionality among Elderly with Dementia: A Cross-Sectional Study https://www.nepjol.info/index.php/JNGMC/article/view/34717 <p><strong>Introduction: </strong>Although cognitive and functional impairment are the hallmark features of Dementia but it is often undetected and neglected as a normal part of aging. So we conducted this study on clinical profile of dementia patients.</p> <p><strong>Aims</strong>: The aim of this study is to evaluate the Patient’s cognitive impairment, functional capacities, and stages of severity of dementia.</p> <p><strong>Methods:</strong> A descriptive cross sectional study was conducted among 50 patients aged 60 years and above, of both sexes with the diagnosis of Dementia, admitted in Medicine ward of Nepalgunj Medical College, Nepalgunj, Nepal. The screening of dementia was done using Mini-Mental State Examination tool and the diagnosis of Dementia was confirmed using the International Classification of Disease-10 Diagnostic Criteria for Research. Cognition, functionality and stages of severity of dementia were assessed using Hierarchic Dementia Scale, Functional Autonomy Measurement System, Functional Assessment Staging Test tools respectively.</p> <p><strong>Results: </strong>Among a total of 50 dementia patients, the mean and standard deviation of age was 82.4±6.1 years, majority of cases 60 % were in the age group ≥85 years and most patients were female 56%. The mean Mini-Mental State Examination score was 9.6±3.0, and 50 % had severe impairment of cognition on Hierarchic Dementia Scale. Stage 7 dementia 32 % was most prevalent stage on Functional Assessment Staging and severe deterioration in the functional autonomy was seen in 54% dementia patients (score ≥41 on Functional Autonomy Measurement System).</p> <p><strong>Conclusion: </strong>This study concludes that significant number of elderly patients attending tertiary care hospital suffers from dementia with severe impairment in cognition and functionality in various stages of dementia in the elderly patients.</p> Niju Niroula Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 3 7 10.3126/jngmc.v18i1.34717 Platelet Count and Its Prognostic Value in Pregnancy Induced Hypertension https://www.nepjol.info/index.php/JNGMC/article/view/35131 <p><strong>Introduction: </strong>Hypertensive disorders of pregnancy is one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.<sup>1</sup> <sup>&nbsp;</sup>&nbsp;It is the leading cause of direct maternal death along with hemorrhage and infections. Approximately 70% of hypertensive disorders are due to gestational hypertension, preeclampsia and eclampsia whereas other 30% are due to preexisting or undiagnosed hypertension.<sup>2 </sup>Out of all the hematological abnormalities that occur in PIH, thrombocytopenia is the most common seen to occur in 11% to 29% of patients.<sup>3</sup> Thrombocytopenia occurs more commonly in patients with eclampsia (30%) compared to patients with both mild and severe forms of pre-eclampsia (15%-18%).<sup>4</sup></p> <p><strong>Aims :</strong>To find out the severity of disease with platelet count in pregnancy induced hypertension.</p> <p><strong>Methods: </strong>This is a hospital- based descriptive cross sectional study, conducted in the department of Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal, conducted over a period of one year from September 2018 to August 2019. Fifty pregnant women were enrolled in study after getting informed written consent and assessing for inclusion and exclusion criteria.</p> <p><strong>Results: </strong>Incidence of Pre-eclampsia/eclampsia is 2.3% in this study. Majority of the women belong to age group 21-25(40%), followed by 15-20(38%) with mean age 23.18±5.45. 62% constituted primigravidas and 38% were multigravidas. 33 (66%) cases were at term (37-42 weeks of gestation), 11(22%) at 34-36 weeks of gestation and 6 (12%) were at 28-33 weeks of gestation with mean gestational age&nbsp; 36.38±3.17. Eclampsia cases were found more i.e. 48%, followed by pre-eclampsia 38% and Gestational hypertension 14%. Moderately low platelet count was seen in 11.76% of Gestational hypertension, 47% of pre-eclampsia and 41.17% of eclampsia and severely low platelet count in 21.4% pre-eclampsia and 64.70% of eclampsia.</p> <p><strong>Conclusion: </strong>PIH continues to be a leading cause of Maternal and perinatal morbidity and Mortality. The disease accounts of 40,000 maternal deaths worldwide per year<sup>5</sup>. It is one of the common causes of iatrogenic preterm delivery. Etiology of Pre-eclampsia/Eclampsia is complex and not completely understood. A combination of abnormal Placentation and predisposing maternal factor contribute to widespread endothelial dysfunctions which lead to the syndrome of PIH. To date there has been no screening test that has been widely adopted in clinical practice. Platelet estimation method is reliable, rapid, cheaper, and simple lab method. Prognosis of diseases could be monitored by measuring platelet count and level of platelet count can predict the severity of PIH. Therefore assessment of platelet count has special place in management of PIH.</p> Nirmala Sharma Sheela Kumari Durga BC Merina Shrestha Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 8 14 10.3126/jngmc.v18i1.35131 Effectiveness of Autologous Blood and Steroid Injection in Tennis Elbow Based on Visual Analog Score Pain Score and Nirschl Stage https://www.nepjol.info/index.php/JNGMC/article/view/35151 <p><strong>Introduction</strong>: Lateral epicondylitis or Tennis elbow is one of the most common causes of lateral elbow pain. Local steroid injection is a time tested treatment for providing symptomatic relief. Local injection of autologous blood in a case of lateral epicondylitis provides pain relief due to its cellular and humoral factor and triggers a healing cascade.</p> <p><strong>Aims:</strong> This study aims to compare the outcomes of the autologous blood injection and local corticosteroid injection in the treatment of tennis elbow.</p> <p><strong>Methods: </strong>This is a Hospital based study on conducted in the Department of Orthopedics at Nepalgunj Medical College from July 2018 to June 2019. 42 patients with unilateral tennis elbow were divided into two groups-Group A-21 patients (Autologous Blood Injection) and Group B-21 patients (Steroid Injection). Group A received 2 ml of autologous venous blood and mixed with 1 ml of 2% lignocaine solution; Group B patients received 80 mg (in 2 ml) of methyl Prednisolone acetate and 1ml of 2% lignocaine solution. Visual Analogue Scale pain score and Nirschl stage of patients were evaluated before injection and at 2, 6, and 12 weeks of injection were noted and analyzed.</p> <p><strong>Results</strong>: Preinjection mean VAS pain score was - 7.48<strong>±</strong>0.75, 7.52<strong>±</strong>0.68 in Group A, and Group B respectively while the Nirschl stage was 5.62<strong>±</strong>0.59 and 5.6<strong>±</strong>0.5 in group A and B, these scores among two group was not statistically significant. At 2 weeks follow up both groups showed improvement without any significant difference between two groups (p=0.84 and 0.549), while group A had better improvement in VAS pain score at 6 weeks (p=0.001). At 12 weeks follow-up within each group, there was significant VAS pain and Nirschl stage improvement (p=0.001) but there was no significant difference between the two groups.</p> <p><strong>Conclusion:</strong> Injection of autologous blood and corticosteroid injection is equally effective in the treatment of Tennis elbow at 12 weeks final follow-up.</p> Gopal Sagar DC Copyright (c) 2021 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 15 17 10.3126/jngmc.v18i1.35151 Incidence, Risk Factors and Immediate Outcome of Preterm Neonates: A Hospital Based Study https://www.nepjol.info/index.php/JNGMC/article/view/35152 <p><strong>Introduction: </strong>Preterm birth is defined as birth before 37 completed weeks of gestation. It is one of the leading cause of infant morbidity and mortality in the world.</p> <p><strong>Aims: </strong>The study was aimed to find out the incidence, possible risk factors and outcome of inborn preterm babies till they were discharged from the hospital.</p> <p><strong> Methods</strong>: This is a prospective hospital based study<strong>. </strong>A total of 100 preterm babies delivered in Nepalgunj Medical College Teaching Hospital, Kohalpur and admitted in Neonatal Intensive Care Unit (NICU) were studied. Preterms were divided into 2 groups extremely to very preterm (&lt;32 weeks) and moderate to late preterm (≥ 32 weeks). The preterm babies were evaluated for various morbidities sand mortality till they were discharged from the hospital.</p> <p><strong>Results:</strong> Data of 100 babies was analyzed. Out of 100 preterm babies 40 were extremely to very preterm babies (&lt;32 weeks) and 60 were moderate to late preterm babies (≥32 weeks). Significant risk factors associated with preterm deliveries were inadequate antenatal visits (73%), primi gravidity (58%), preterm premature rupture of membrane (55%), urinary tract infection (54%), anemia (53%), teenage pregnancy (43%), antepartum hemorrhage (41%) and pregnancy induced hypertension (33%). The total mortality was higher in extremely to late preterm than in moderate to late preterm. The most common causes of mortality were Neonatal sepsis (NNS), Hyaline Membrane Disease (HMD) and Birth Asphyxia.</p> <p><strong>Conclusion: </strong>The hospital incidence of preterm neonates is still very high. The major risk factor seen in the study was inadequate antenatal visit. Preventive measures, early identification of risk factors will improve the outcome.</p> Niraj Acharya Sumita Poudel Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 18 21 10.3126/jngmc.v18i1.35152 Efficacy of Tranexamic Acid in Reducing Blood Loss during and After Caesarean Section: A Case control Study https://www.nepjol.info/index.php/JNGMC/article/view/35154 <p><strong>Introduction: </strong>The incidence of caesarean section is increasing day by day. One of the most common complications is primary or secondary postpartum haemorrhage. Tranexamic acid has been shown to be very useful in reducing blood loss and incidence of blood transfusion in varieties of surgery.</p> <p><strong>Aims: </strong>To study the efficacy of tranexamic acid in reducing blood loss during and after the lower segment caesarean section.</p> <p><strong>Methods</strong>: Arandomized, case controlled, prospective study was conducted on 100 women undergoing lower segment caesarean section carried out in the Department of Obstetrics and Gynaecology, Nepalgunj Medical College, Kohalpur from Sept 2019 to Feb 2020<strong>.</strong>Fifty of them were given tranexamic acid immediately before lower segment caesarean section and were compared with 50 others to whom tranexamic acid was not given. Blood loss was collected and measured during two different time interval. The first period was considered from placental delivery to end of lower segment caesarean section and second from the end of lower segment caesarean section to 2 hours postpartum period. Vital signs at time of delivery, at 1 hour and 2 hour postpartum and APGAR score at 1 min and 5 min were studied in both the groups.</p> <p><strong>Results</strong>: Tranexamic acid significantly reduced the quantity of blood loss from the placental delivery to 2 hours post-partum: 360.9 ml in the study group, versus 443 ml in the control group (p=0.0008).It also significantly reduced the quantity of blood loss from the end of lower segment caesarean section to 2 hours postpartum:71.5 ml in the study group versus 112.6 ml in the control group (p=0.0002).There was 18% less incidence of postpartum haemorrhage , who received tranexamic acid(p=0.02).There were no significant adverse drug reaction and difference in APGAR score in both the groups. No complications or side effects were reported in either group.</p> <p><strong>Conclusion</strong>: Tranexamic acid is safe and effective in reducing blood loss among women undergoing lower segment caesarean section.</p> Kavita Sinha Subhash Pandey Dipendra Khadka Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 22 25 10.3126/jngmc.v18i1.35154 Treatment Outcome of Métaizeau Technique of Intramedullary Pinning in Pediatric Displaced Radial Neck Fracture https://www.nepjol.info/index.php/JNGMC/article/view/35172 <p><strong>Introduction: </strong>Displaced radial neck fracture in children when poorly managed results in deformity of elbow and incapacitates patient’s daily activities due to compromised forearm motion, hence they require careful attention.</p> <p><strong>Aims: </strong>The aim of this study is to assess the outcome of Métaizeau Technique in displaced radial neck fracture in Children.</p> <p><strong> Methods: </strong>This hospital based study evaluated the treatment outcome of 35 patients with an average age of 9.34 years (range, 6 – 14 years), who presented with displaced radial neck fracture; and were treated by Métaizeau technique of intramedullary pinning by Kirschners (K) wire at Nepalgunj Medical College, Kohalpur from April 2017 to January 2020. Only Judet’s type 3 and 4 fractures were included in this study. Close reduction was attempted in all cases. All patients were followed up for an average of 8.4 months (range, 6-12 months). Functional outcome was assessed as per Métaizeau functional score.</p> <p><strong>Results: </strong>All fractures united at an average of 3.77 0.84 months (meanSD). Twenty seven patients had type 3 fracture and remaining 8 had type 4a fracture. Twenty five (92.5%) patients with type 3 fracture exhibited excellent results; while three patients (37.5%) with type 4a fracture had excellent outcome. Closed reduction produced excellent outcome in all patients while 80.95% patients with percutaneous reduction had excellent result.</p> <p><strong>Conclusion: </strong>Outcome depends on initial fracture type and mode of reduction. Closed reduction should be preferred over an open reduction in order to achieve superior outcome.</p> Prateek Karki Roshani Ranabhat Aman Shah Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 26 30 10.3126/jngmc.v18i1.35172 Assessment of the Status of Contralateral Ear in Post-Operative Subjects of Unilateral Chronic Otorrhoea https://www.nepjol.info/index.php/JNGMC/article/view/35174 <p>I<strong>ntroduction</strong>: Chronic otitis media is one of the most common ear diseases in developing countries like Nepal and is important cause of the hearing loss. Chronic otitis media is rarely an isolated entity, because the responsible factors for its development in one ear in similar way will impact the contralateral ear, since both ears have a common “nasopharyngeal” drainage. Contralateral ear is defined as asymptomatic ear in cases of unilateral chronic otitis media.</p> <p><strong>Aims: </strong>To evaluate the audiological profile of Contralateral ear in post-operative subjects of unilateral otorrhoea.</p> <p><strong>Methods: </strong>Patients fulfilling criteria underwent Otoscopic examination, tuning fork test and pure tone audiometry. The findings of contralateral ear like retraction, tympanosclerotic patch (TS patch), thin, dull and atrophied tympanic membrane were noted. The final diagnosis with the type of surgery of diseased ear, as well as status of contralateral ear were entered into the proforma. All the patients were followed till three months in relation to anatomy of Tympanic membrane onotomicroscopy and pure tone audiometry respectively.</p> <p><strong>Results:</strong> In postoperative cases of mucosal disease, the cases with abnormality in the contralateral ear reduced from 17 to 10 patients (30.3%) and the normal patients increased from 16 to 23 cases (69.7%). Likewise, in postoperative squamous disease, the cases with abnormality in the contralateral ear reduced from 14 to 11 patients (64.7%) and the normal patients increased from 3 to 6 cases (35.3%). Out of 50 cases, 14 cases (28%) had defective hearing while 36 cases (72%) had normal hearing in the contralateral ear respectively.</p> <p><strong>Conclusion: </strong>The high incidence of occurrence of abnormality in contralateral ear indicate that both ears should be regarded as a pair. Unilateral Chronic otitis media should not be taken as a static phenomenon but as a continuous process in the other ear too.</p> Shama Bhandari Sulav Shrestha Dhundi Raj Paudel Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 31 35 10.3126/jngmc.v18i1.35174 Normal Pituitary Gland Size and Morphology and Its Variations Related To Age and Gender: An MRI Evaluation https://www.nepjol.info/index.php/JNGMC/article/view/35175 <p><strong>Introduction:</strong> The pituitary gland is regarded as the master endocrine gland of the body. Subtle alterations in the size can cause significant changes to other endocrine glands and hormonal status. Magnetic Resonance Imaging (MRI) is the investigation of choice to examine pituitary gland. It is important to know the range of normal size and variations according to age and gender to enable radiologists to suggest what might be an abnormal pituitary gland.</p> <p><strong>Aims</strong>: This study aims to examine normal size, volume and shape of pituitary gland and to establish a normal reference value for pituitary size in different age groups and genders.</p> <p><strong>Methods:</strong> MRI Brain of 137 patients were studied retrospectively and patients with endocrinal abnormalities were excluded from the study. Images were acquired in General Electronics 1.5 Tesla MRI machine and mid-sagittal T1WI and coronal T2WI were selected for accurate measurement of the gland. Height, AP diameter, Transverse diameter, and volume were calculated for each individual and the collected data was categorized based on age and sex for analysis. Pearson’s correlation test was done to establish a relation between age and volume of the gland and a p-value of &lt;0.05 was considered as significant.</p> <p><strong>Results:</strong> Our study included 137 patients (57 males, 80 females) with age ranging from 3 to 86 years. The study was divided into six age groups. Mean pituitary height, AP diameter, transverse diameter and volume of the gland were 6mm, 8.9mm, 12.3 mm, and 354.5 mm<sup>3</sup> respectively. The gland observed a gradual increase in size up to the third decade and was more pronounced in the female population. A steady decline in the size of the gland was noted after 30 years for both populations.</p> <p><strong>Conclusion:</strong> Good understanding of the normal size and shape of pituitary gland and its variation with age and gender is a must for every radiologist to compare with an abnormal increase in size.</p> Amit Jha Nabin Paudel Sabin Nepal Rajesh Nayak Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 36 39 10.3126/jngmc.v18i1.35175 Correlation of Epithelial Cell Abnormality in Cervical Cytology with Cervical Histology https://www.nepjol.info/index.php/JNGMC/article/view/35180 <p><strong>Introduction:</strong> Cervical cancer is the second most common cancer in females worldwide and third most common cancer in Nepal. Conventional Pap smear is the most widely used screening tool for detecting premalignant and malignant lesions of cervix. Cytohistological correlation of Pap smear is a widely accepted method for analysis of various factors leading to discrepancies in diagnosis and internal quality assurance.</p> <p><strong>Aims</strong>: To study the cytohistological correlation of epithelial cell abnormality in Pap smear in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal.</p> <p><strong>Methods:</strong> This is a hospital based prospective cross sectional study carried out at Department of Pathology, NGMC, Kohalpur, Nepal from August 2018 to January 2020. The study included 137 cases of Pap smear with epithelial cell abnormality and correlated with corresponding histopathological findings.</p> <p><strong>Results:</strong> The age of patients ranged from 20-80 years with the number of cases seen in the range of 30-39 years (n=44; 32.1%). Whitish discharge per vaginum was most common presenting symptom. High grade squamous intraepithelial lesion (HSIL) was the most common abnormal finding in Pap smear with a frequency of 40 (29.1%) cases. Out of 137 cases of Pap smear 57 (41.6%) cases showed discrepancies in cervical biopsy. All cases of Squamous Cell Carcinoma (SCC) were correctly diagnosed by Pap smear. The overall sensitivity of smear test was 84%. After evaluating cytohistological correlation, the Positive Predictive Value (PPV) was found to be 100% for SCC, 52% for HSIL and 59% for Low grade squamous intraepithelial lesion (LSIL).</p> <p><strong>Conclusion</strong>: The current study revealed a good correlation between cervical cytology and biopsy in Pap smear showing epithelial cell abnormalities. Thus, cytology and histology are complementary to each other and helps to reduce discrepancies.</p> Richa Shrestha Kavita Sinha Nirmala Sharma Anil Shrestha Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 40 43 10.3126/jngmc.v18i1.35180 Role of Cortical Mastoidectomy in the Management of Safe Chronic Otitis Media https://www.nepjol.info/index.php/JNGMC/article/view/35181 <p><strong>Introduction:</strong> Role of cortical mastoidectomy in tympanoplasty for Chronic Otitis Media Mucosal inactive disease is controversial. Some arguments are in favor and suggest that cortical mastoidectomy increases the air reservoir in the mastoid and also help in achieving the patency of aditus but others believe that the ingrowths of squamous epithelium, potential for injury to the inner ear structures and facial nerve during mastoid surgery outweighs the beneficial effects on tympanic membrane healing.</p> <p><strong>Aims:</strong> To assess the hearing improvement and graft uptake in patients undergoing Tympanoplasty and Tympano-mastoidectomy in chronic otitis media mucosal inactive disease.</p> <p><strong>Methods:</strong> This was a comparative study comprises of 50 patients with Chronic Otitis Media Mucosal inactive ear, conducted in the patients attending the department of ENT in NGMC teaching hospital from Nov 2017 to May 2019. All cases were operated during a period of one half year. 25 patients were selected for tympanoplasty (Group A) and 25 patients were selected for Tympanoplasty with cortical mastoidectomy (Group B).</p> <p><strong>Results:</strong> There were 14(28%) male and 36(72%) female, with mean age of 28. 36 years, ranging from minimum of 13 years to maximum 56 years. The postoperative audiograms were recorded after 3 months. Type I tympanoplasty with cortical mastoidectomy has better graft uptake (96%) as compared to without mastoidectomy (84%). Post-operative hearing improvement is almost equal in tympano-mastoidectomy (13.24 dB) and tympanoplasty (13.04 dB).</p> <p><strong>Conclusion:</strong> Post-operative hearing gain almost equal in both study group but graft uptake was better with tympano-mastoidectomy then tympanoplasty alone in present study.</p> Lok Ram Verma Dhundi Raj Paudel Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 44 48 10.3126/jngmc.v18i1.35181 Knowledge, Attitude and Practice of Self-Medication among Nursing Students of Nepalgunj Nursing Campus Kohalpur Banke https://www.nepjol.info/index.php/JNGMC/article/view/35183 <p><strong>Introduction</strong>: Self-medication is widely practiced among the nursing students because of easy availability and accessibility of the drugs. Inappropriate self-medication can leads to increased resistance among pathogens, wastage of resources, can cause serious harm and increase morbidity; which indicates needs of responsible self-medication.</p> <p><strong>Aims</strong>: This study was to assess the self-medication knowledge, attitude and practice among nursing students.</p> <p><strong>Methods</strong>: This was a questionnaire based descriptive cross sectional study conducted in Nursing students of Nepalgunj Nursing Campus, Kohalpur, on August 2019. Questions related to various aspects of self-medication was used for data collection.</p> <p><strong>Results:</strong> Out of 120 students, 102 (85%) students were found practicing self-medication with reason of no need to visit the doctor for minor illness 78%, for quick relief 75% and for time saving 50%. Only 15% not taken self-medication reasoning there was risk of adverse effects 65% and risk of using wrong drugs 60%. The source of information of the drugs used for self-medication was previous prescription and text book was 50% and 35% respectively and the source of the drugs was medical store, 88.2%. Majority of 96% took for headache followed by fever 83.3%; menstrual symptoms 68.6%; and cough and cold 68.6% and dirrhoea 64.7%. Most of the students 96% took analgesics and antipyretics drugs.</p> <p><strong>Conclusion:</strong> Our study shows that self-medication is significantly practiced by nursing students. There is need to aware them about advantages and disadvantages of self-medication in order to ensure safety and proper use of drugs.</p> Dabal Bahadur Dhami Sanjeeva Dhakal Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 49 51 10.3126/jngmc.v18i1.35183 Comparison of Tramadol with Combination of Tramadol and Ketorolac for Post Cesarean Section Analgesia https://www.nepjol.info/index.php/JNGMC/article/view/35185 <p><strong>Introduction</strong>: Effective post-operative analgesia is mandatory following cesarean section (CS), as parturients need to recover quickly to breast feed and provide care for their newborns. Till date no single drug has been able to achieve this goal. Multimodal analgesia with opioids and non-steroidal anti-inflammatory drugs (NSAID) combination has shown promising results. </p> <p><strong>Aims</strong>: To compare the analgesic efficacy, patient satisfaction and maternal adverse effects, between intravenous (IV) tramadol and multimodal analgesia with IV tramadol and IV ketorolac combination for post cesarean section analgesia.</p> <p><strong>Methods</strong>: This is a prospective, randomized and single-blinded comparative study, conducted in 60 parturients who underwent Lower Segment Cesarian Section. They were divided into two groups: Group 1 (IV Tramadol 50 mg given 8 hourly) and Group 2 (IV Tramadol 50 mg + IV Ketorolac 30 mg given 8 hourly). IV Promethazine was given with each dose of tramadol in both groups.</p> <p><strong>Results</strong>: The (Visual analogue scale) VAS scores were significantly low in IV tramadol + IV ketrolac group than with IV tramadol alone group at 2 hours and 12 hours with p value of 0.003 and 0.08 respectively. Rescue analgesia was significantly reduced in group 2 (p value 0.005). Patient satisfaction was good in group 2 and fair in group 1(p value 0.002). No maternal side effects were found.</p> <p><strong>Conclusion</strong>: IV tramadol and IV ketorolac combination used for post cesarean section analgesia significantly decreases post-operative pain, need of rescue analgesia and significantly increases patient satisfaction in comparison to IV tramadol alone.</p> Nabin Kumar Regmi Kamar Jahan Purnima Rai Ankur Bhandari Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 52 55 10.3126/jngmc.v18i1.35185 Functional Outcome of Galezzi Fracture Dislocation in Adults Treated With Dynamic Compression Plate and Kirschner Wire https://www.nepjol.info/index.php/JNGMC/article/view/35189 <p><strong>Introduction:</strong> Galeazzi fracture-dislocation is a complex traumatic disruption of the distal radioulnar joint (DRUJ) that is associated with lower shaft radius fracture. Galeazzi fractures are extremely unstable, and the results of nonsurgical treatment are uniformly unsatisfactory. Galeazzi fractures managed with closed modalities have unsatisfactory clinical results in most of the patients in published literature so open reduction and internal fixation with plating is the standard treatment for this fracture.</p> <p><strong>Aims</strong>: The aim of this study was to evaluate the functional outcome of Galeazzi fracture dislocation.</p> <p><strong>Methods:</strong> This prospective study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur, from April 2016 to March 2019. It included 35 patients of age group 19 to 49. All of the fractures in this study were treated by open reduction and internal fixation (ORIF) with 3.5 mm narrow dynamic compression plate (DCP) and cortical screws via Henrys anterior approach and distal radioulnar joint (DRUJ) stabilization was done with 1 Kirschner wire (K-wire) inserted parallel to the wrist joint. Patients were observed at 6, 10, 16 and 24 weeks and 52 weeks both radiographically and clinically.</p> <p><strong>Results: </strong>In this study of 35 patients, 24 (68.57%) were males and 11 (31.43%) were females with the age range of 19 to 49 years and mean age of 35 and standard deviation (SD) of ±1.5 years. Majority of fractures were observed between 31 to 40 years of age. Most of the injuries were due to fall injury 51.42%. The average duration from time of injury to surgery was 5 days and bone grafting was not needed in any cases. The average time period for union was about 16 weeks. The most common complication seen in this study was stiffness of wrist (11.42%). Twenty four patients (68.57%) had good result, 10 patients (28.57%) had fair result and one patient (2.86%) had poor result in DASH score at final follow-up.</p> <p><strong>Conclusion:</strong> Open reduction and internal fixation with plating and stabilization of distal radioulnar joint with K wire yields good to fair outcome on Disabilities of Arm, Shoulder and Hand Score.</p> Dipendra KC Dinesh Kumar Shrestha Prateek Karki Sabin Shrestha Sushil Yogi Sagar Giri Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 56 59 10.3126/jngmc.v18i1.35189 Hearing Loss in Low Birth Weight Neonates: A Comparative Study at Nepalgunj Medical College and Teaching Hospital https://www.nepjol.info/index.php/JNGMC/article/view/35190 <p><strong>Introduction: </strong>Hearing impairment is the most common congenital abnormality that occurs in 1 to 4/1000 newborns. It has a profound effect on their optimal development of language, speech and cognitive skill. Early detection in order to achieve effective treatment is essential. An association between low birth weight and hearing loss is commonly associated with multiple risk factors that can alter hearing in a synergistic fashion. Universal neonatal hearing screening programs have become widely implemented aiming for the screening, confirmation of the diagnosis and intervention by 1, 3 and 6 months respectively. Transient Evoked Otoacoustic emissions is one of the test found to be a quick, objective, non-invasive, accurate and easy test for early detection of this problem. </p> <p><strong>Aims</strong>: Early detection of hearing loss in neonates focusing on low birth weight for early optimum rehabilitation.</p> <p><strong>Methods</strong>: A comparative case control study conducted in 100 neonates under 2 groups. 50 neonates with low birth weight and 50 with normal birth weight who were born at NGMCTH, Kohalpur. Their hearing evaluation was done with Transient Evoked Oto Acoustic Emission (TEOAE).</p> <p><strong>Results</strong>: The total referral rate was 12 % and pass rate was 88 %. The referral rate in LBW group was 20 % and 4 % in normal weight neonates. The pass rate in low birth weight was 80 % and 96 % in normal weight babies.</p> <p><strong>Conclusion</strong>: Hearing impairment is a severe consequence in neonates with low birth weight. To decrease the economic and social burden of effects of hearing loss, it is assumed that newborn screening can immeasurably improve the future of newborn with early rehabilitation.</p> Anshu Sharma Ravinder Saxena Dhundi Raj Paudel Kumar Shrestha Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 60 62 10.3126/jngmc.v18i1.35190 A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure https://www.nepjol.info/index.php/JNGMC/article/view/35193 <p><strong>Introduction: </strong>Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting.</p> <p><strong>Aims: </strong>To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound.</p> <p><strong>Methods: </strong>This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence.</p> <p><strong>Results: </strong>The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of &lt;0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0).</p> <p><strong>Conclusion</strong>: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications</p> Shiv Vansh Bharti Anup Sharma Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 63 66 10.3126/jngmc.v18i1.35193 Study of Correlation Between Glycated Hemoglobin (Hba1c) and Serum Lipid Profile in Type 2 Diabetic Patients https://www.nepjol.info/index.php/JNGMC/article/view/35200 <p><strong>Introduction:</strong> Diabetic mellitus is a chronic metabolic disease characterized by hyperglycemia. Type 2 diabetes mellitus accounts for more than 90% of cases worldwide. Elevated HbA1c and dyslipidemia proportionately increases the risk of development of cardiovascular disease (CVD) which is the major cause of morbidity and mortality worldwide.</p> <p><strong>Aims</strong>: To Study the correlation between glycated hemoglobin (HbA1c) and serum lipid profile in type 2 diabetic patients.</p> <p><strong>Methods</strong>: This is a hospital based cross sectional study conducted at Nepalgunj medical college teaching hospital, which included 104 type 2 diabetic patients (54 males and 50 females).Venous blood samples were collected from all patients and serum was used for analyzing HbA1c, lipid profile panel and fasting blood glucose (FBG). DM was defined as per American diabetic association (ADA) criteria. Dyslipidemia was defined as per the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guidelines. The data were analyzed using standard statistical methods, including SPSS 21.</p> <p><strong>Results</strong> : Abnormal lipid parameters were demonstrated with increased Total Chloseterol (TC), Triglyceride (TG), Low density lipoprotein (LDL),Very low density lipoprotein (VLDL) and low High density lipoprotein (HDL) suggestive of dyslipidemia.HbA1c showed direct and significant correlation with TC,LDL,TG and VLDL. Patients with HbA1c &gt; 7.0% had a significantly higher value of TC, LDL, TG and VLDL as compared to patients with HbA1c ≤7.0%.However, the significant difference in value of HDL-C was not found between two groups.</p> <p><strong>Conclusion</strong>: Due to the strong correlation with lipid profile, HbA1c could be the ideal marker for predicting dyslipidemia in type 2 DM . Patients with higher HbA1c value and dyslipidemia should be considered as a very high risk group for CVD.</p> Anil Shrestha Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 67 69 10.3126/jngmc.v18i1.35200 Risk Factors and Outcomes of Low Birth Weight Neonates Admitted In a Tertiary Care Center https://www.nepjol.info/index.php/JNGMC/article/view/35202 <p><strong>Introduction:</strong> Birth weight &lt;2500 grams, &lt;1500 grams and &lt;1000 grams irrespective of gestational age is low birth weight, very low birth weight and extremely low birth weight respectively. Low birth weight is associated with high morbidity and mortality.</p> <p><strong>Aims: </strong>To find out the possible maternal risk factors associated with low birth weight babies, morbidities and mortalities seen in them during their hospital stay.</p> <p><strong>Methods: </strong>Hospital based cross sectional observational study was performed in 200 newborns &lt;2500 grams in Nepalgunj Medical College, Kohalpur, Banke, Nepal.</p> <p><strong>Results: </strong>Out of 200 neonates 8 (4%), 40 (20%) and 152 (76%) were extremely low birth weight, very low birth weight and low birth weight respectively with Male:Female ratio of 1.12:1. Most common maternal risk factors for low birth weight was Illiterate mothers (88%) followed by preterm delivery (68%). Inadequate antenatal visit was associated with low birth weight (P&lt;0.05). Most common morbidity seen in low birth weight was neonatal sepsis (96%) followed by neonatal jaundice (87%). 44 (22.0%) neonates expired and 156 (78.0%) survived<em>. </em>Neonatal sepsis was most common (36.4%) cause of mortality followed by respiratory distress syndrome (22.7%).</p> <p><strong>Conclusion: </strong>Certain measures could be taken to prevent low birth weight deliveries: discouraging delivery at teenage, adequate antenatal visits, avoiding smoking and alcohol during pregnancy. Well trained staffs and better facilities in neonatal intensive care unit could improve the survival and minimize the morbidities in low birth neonates.</p> Jyoti Adhikari Rajesh KC Shristi Kharel Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 70 73 10.3126/jngmc.v18i1.35202 Chest X-Ray in Coronavirus Disease 2019 (COVID-19) Infection: Findings and Correlation with Clinical Outcome at Level-3 Nepalgunj Medical College and Teaching Hospital Kohalpur https://www.nepjol.info/index.php/JNGMC/article/view/35204 <p><strong>Introduction</strong>: At the end of 2019 a novel virus, named SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), expanded globally from China. A new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was identified as the cause of this outbreak of viral pneumonia that causes coronavirus disease 2019 (COVID-19).</p> <p><strong>Aims</strong>: The aim of this study is to find out the chest radiological features of corona virus disease patients and correlate them with clinical outcome.</p> <p><strong>Methods</strong>: This is a Hospital based study involving patients with clinical-epidemiological aspect of all reverse transcription polymerase chain reaction (RT-PCR) corona virus disease (COVID-19) positive patients, who performed Chest X-Rays at the emergency department of Nepalgunj Medical College, Teaching Hospital from March to June, 2020. All patients performed reverse transcription polymerase chain reaction from nasopharyngeal and throat swab, Chest X-Ray at the Emergency Department and clinical-epidemiological data.</p> <p><strong>Results</strong>: Patients with a reverse transcription polymerase chain reaction positive results for corona virus disease infection were 32 out of these, 22 were females (68.75%) and 10 males (31.25%), with a mean age of 40.78 years (range 20–74 years). Only 2 Chest X-Rays were negative for radiological thoracic involvement (6.25%). The following alterations were more commonly observed among 30 patients: 18 patients with lung consolidations (56.25%), 19 (59.37%) with Ground Glass Opacities, 7 (21.87%) with nodules and 21 (65.6%) with reticular–nodular opacities. Patients with consolidations and Ground Glass Opacities coexisting in the same radiography were 34.37% of total. In reverse transcription polymerase chain reaction positive patients, we found also signs nonspecific for corona virus disease pneumonia as hilar or vascular congestion (37.5%), cardiomegaly (28.12%), pleural effusion (15.6%) and pneumothorax (3.12%). Peripheral (56.25%) and lower zone distribution (56.25%) were the most common predominance. Bilateral involvement (68.75%) was most frequent than unilateral one. Given the results, baseline Chest X-Rays sensitivity in our experience is about 65.62%.</p> <p><strong>Conclusion</strong>: In this study, COVID-19 CXRs generally manifested a spectrum of pure ground glass, mixed ground glass opacities to consolidation in bilateral peripheral middle and lower lung zones. BSTI CXR reporting classification of COVID-19 is valid and sensitive in our patients with addition of middle zonal involvement in classical COVID-19 criteria as opposed to just lower zone involvement.</p> Shyam Kumar BK Sumit Pandey Nabin Poudel Sandesh Pandit Alok Kumar Sah Hitesh Neupane Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 74 77 10.3126/jngmc.v18i1.35204 Comparative Study of Autologous Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients with End Stage Renal Disease https://www.nepjol.info/index.php/JNGMC/article/view/35206 <p><strong>Introduction: </strong>End-stage renal disease requires treatment with dialysis or renal transplantation. For the dialysis, autologous radiocephalic (RC) or brachiocephalic (BC) arteriovenous fistula (AVF) is the better option for vascular access for hemodialysis.</p> <p><strong>Aims</strong>: The aim of this study is to find out the outcome between RC AVF and BC AVF.</p> <p><strong>Methods</strong>: This is the retrospective study, conducted for the period of 24 months from September 2017 to September 2019 in the department of Cardiothoracic and Vascular Surgery of Bir Hospital, Nepal. RC and BC AVF were created for the assess of hemodialysis. Outcome and different complications were taken into consideration. </p> <p><strong>Results</strong>: The total number of patients included in this study was 400. The overall failure rate of autologous AV fistula was 12.75%. Out of these, the failure rate was more in RC AV fistula group, 34 (17%) than in BC AV fistula group, 17 (8.5%). The most common complication was bleeding in both groups having an overall rate of 39 (9.75%). The limb edema was more common in BC AV fistula group 16 (8.0%) then in RC AV fistula group 7(3.5%). The overall infection rate was 4.5%. Overall patency rate was 87.25%.</p> <p><strong>Conclusion</strong>: Autologous RC AVF and BC AVF are the choices for vascular access for hemodialysis in patients with end-stage renal disease. BC AVF has a better patency rate than RC AVF but with the slight higher risk of complications.</p> Deepak Thapa Magar Kiran Shrestha Dinesh Chapagain Kumar Shrestha Sara Thapa Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 78 81 10.3126/jngmc.v18i1.35206 Socio Demographic Profile and Risperidone Response in New Versus Old Schizophrenia Patients https://www.nepjol.info/index.php/JNGMC/article/view/35208 <p><strong>Introduction:</strong> Schizophrenia is a mental disorder characterized with disorganized thinking, perception, expression of reality with significant social and occupational dysfunction. Two groups of drugs are in recent use namely first generation (typicals) and second generation (atypical) antipsychotics. Risperidone is a broad spectrum antipsychotic and has a role as a first-line agent for first break, mild to moderately ill patients and for severely ill treatment–refractory patients.</p> <p><strong>Aims</strong>: This article tries to compare the risperidone response in newly diagnosed schizophrenia patients versus old patients already on some antipsychotics other than risperidone.</p> <p><strong>Methods</strong>: This is an experimental intervention study of patients attending to psychiatry OPD and indoor in Nepalgunj Medical College, Kohalpur. Total 40 patients (27 new and 13 old) were selected and sample was collected in one year from January 2018 till December 2018. Positive and negative syndrome scale questionnaire was used to record the positive and negative symptoms of schizophrenia on baseline (week 0). Patients were followed up on week 4 and week 8 and the same positive and negative syndrome scale questionnaire was applied to record the improvement. Risperidone was given in therapeutic dose (4-8mg) on the basis of symptoms and improvement.</p> <p><strong>Results</strong>: The study subjects were divided into new N=27 (17 male and 10 female) and old N=13 (7 male and 6 female). Maximum number of schizophrenia cases were in age group 15-25 and 35-44 years comprising 30 % in each group. Mean total duration of illness in new group was 23.89 ± 29.51 months (median being 12.0 months) while in old group it was 123.69 ± 83.34 months (median being 96.0 months) with significant difference between two groups <strong>(p= &lt;0.001)</strong>.The mean risperidone dose in milligram on base line (week 0) was 4.15 ± 0.55 for old group while it was 4.04 ± 0.52 for new group. On week 4, the mean dose for old group was 5.08 ± 0.95 while for the new group it was 4.81 ± 1.08. On week 8, the dose for old group was 6.08 ± 1.32 while it was 5.15 ± 1.35 for new group. There was a significant difference in the drug dose on week 8 between old group and new group with p value of <strong>0.047</strong> (statistically significant). </p> <p><strong>Conclusion</strong>: Our study suggests that schizophrenia is found in most productive age group. Risperidone is effective in both new and old schizophrenia patients however old patients need higher dose of risperidone than new patients.</p> Mohan Belbase Jyoti Adhikari Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 82 85 10.3126/jngmc.v18i1.35208 Validation of WHO-IMNCI Algorithm for Jaundice in 0-2 Months Aged Infants at Tertiary Level Hospital https://www.nepjol.info/index.php/JNGMC/article/view/35210 <p><strong>Introduction:</strong> For the effective management of these major childhood illnesses, WHO and UNICEF have developed the “Integrated Management of Neonatal and Childhood Illness” (IMNCI) Strategy.</p> <p><strong>Aims:</strong> The aim of study is to evaluate the utility of the WHO/ UNICEF algorithm for Integrated Management of Neonatal and Childhood Illness (IMNCI) for jaundice up to two months of age.</p> <p><strong>Methods:</strong> This is Prospective observational comparative study. Total of 300 subjects were taken from Emergency and Outpatient Department of Pediatrics. The treatment steps were identified as according to the ‘Assess and Classify’ module of IMNCI algorithm. All relevant investigations were performed, using appropriate methods. Blood sugar was done in all recruited children and serum bilirubin levels were done in all infants presented with jaundice. Based on this detailed clinical evaluation and relevant investigations, final diagnosis were made and therapies were given. These diagnosis and treatments were considered as the ‘Gold Standard’ for comparison.</p> <p><strong>Results:</strong> There were 300 young infants, of whom 162(54%) were male and 138(46%) were female infants. Total of 146 infants were admitted, 24 from OPD and 122 from Emergency. 154 infants were sent home after initial management in hospital. Severe jaundice was present in 24 infants according to IMNCI and 12 infants according to Gold Standard in 0-2 months of age. The predictive utility of algorithm for the diagnosis of severe jaundice with a sensitivity of 100%, specificity of 75%, positive predictive value of 50% and negative predictive value of 100% in 0-2 months of age group.</p> <p><strong>Conclusion:</strong> Algorithm performed well in identifying severe jaundice with the sensitivity of 100% and specificity of 95%.</p> Piush Kanodia Sameer Mahaseth Vishnu Paranjuli Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 86 89 10.3126/jngmc.v18i1.35210 Effectiveness of Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocation Using Clavicle Hook Plate and Tension Band Wiring: A Comparative Study to Evaluate the Functional and Surgical Outcome https://www.nepjol.info/index.php/JNGMC/article/view/35211 <p><strong>Introduction:</strong> Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews.</p> <p><strong>Aims: </strong>To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires.</p> <p><strong>Methods</strong>: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. </p> <p><strong>Results</strong>: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 &amp; max. 93) in clavicular hook plate and 74.72 (min 68 &amp; max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. </p> <p><strong>Conclusion</strong>: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.</p> Dinesh Kumar Shrestha Merina Shrestha Dipendra KC Prateek Karki Sabin Shrestha Sushil Yogi Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 90 95 10.3126/jngmc.v18i1.35211 Outcomes of Percutaneous Nephrolithotripsy With or Without Nephrostomy Tube: A Comparative Study https://www.nepjol.info/index.php/JNGMC/article/view/35213 <p><strong>Introduction:</strong> Percutaneous Nephrolithotripsy (PCNL) is one of the most accepted surgical modality for removal of renal stone. Placement of a nephrostomy tube at the end of PCNL is a standard procedure for PCNL, however many reports have showed the safety and efficacy of tubeless PCNL for the removal of renal stone.</p> <p><strong>Aims:</strong> The present study aimed to report the outcomes of PCNL with or without nephrostomy tube.</p> <p><strong>Methods</strong>: It is Prospective Hospital Study conducted from June 2017 to April 2020 in the Department of Urology Nepalgunj Medical College. Total 153 patients under inclusion criteria were divided into two groups. Group 1 (75 patients) was allocated to patients who were being treated under standard PCNL procedure while Group 2 (78 patients) was allocated for patients who were being treated under Tubeless PCNL procedure. The two groups were compared for operation time (minutes), hospital stay (days), post operative dose of analgesic (mg), post operative complications such as, leakage (%), bleeding (%) and infection (%). Data were analyzed from SPSS and p-value less than 0.5 was considered as significant.</p> <p><strong>Results:</strong> In Group II the mean hospital stay, analgesic dose and rate of leakage was significantly lesser than Group I (p&lt;0.05) whereas, the mean operation time, rate of infection and bleeding were not significantly different between two groups (p&gt;0.05).</p> <p><strong>Conclusion</strong>: Tubeless PCNL procedure causes more rapid recovery and earlier discharge from the hospital, reduction in postoperative pain and no leakage when compared to standard tubless PCNL.</p> Naresh Man Shrestha Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 96 99 10.3126/jngmc.v18i1.35213 Mid-Trimester Scan is better for Detecting Congenital Anomalies: An Experience from Dhulikhel Hospital https://www.nepjol.info/index.php/JNGMC/article/view/35220 <p><strong>Introduction: </strong>Ultrasound is a valuable diagnostic tool for detecting the congenital anomalies in the fetus. Congenital anomalies are detected in 14% of new born. Major anomalies are detected in 2 to 5% of new born. This accounts for 20 % to 30% of total perinatal deaths. Prenatal diagnosis provides variety of management options for the pregnant women ranging from termination of pregnancy, elective delivery or intrauterine manipulation of the anomalies.</p> <p><strong>Aims: </strong>To determine the prevalence of the fetal congenital anomalies at 20- 24 weeks ultrasonography.</p> <p><strong>Methods: </strong>This is prospective study conducted at Dhulikhel Hospital. Pregnant ladies with singleton pregnancy at 20 to 24 weeks were enrolled for transabdominal ultrasound for detecting congenital anomalies.</p> <p><strong>Results: </strong>Of 1027 pregnant ladies screened, anomalies were detected in 31 ladies during mid trimester ultrasound. The overall prevalence of congenital anomalies detected in our study is 3.02% (31 cases), which has sensitivity of 87.8%, specificity of 99.7% and positive predictive values of 93.5%. In our study, mean gestational age during scan was 21<sup>+5 </sup>weeks of gestation. And 13 pregnant ladies pregnancies were terminated between 20-24 weeks for having major congenital anomaly in fetus.</p> <p><strong>Conclusion:</strong> Mid trimester ultrasonography is a valuable method for pregnant ladies to detect the congenital anomalies in fetus. When major anomalies are detected, timely termination of pregnancy have saved the cost and tragedy of losing viable fetus.</p> Suman Raj Tamrakar Rubina Shrestha Copyright (c) 2020 Journal of Nepalgunj Medical College 2020-12-31 2020-12-31 18 1 100 104 10.3126/jngmc.v18i1.35220