Nepal Journal of Medical Sciences 2019-09-06T08:34:19+00:00 Dr Umid Kumar Shrestha, MD, PhD Open Journal Systems <p>Official Journal of Manipal College of Medical Sciences. Full text articles available.</p> Message from the Editorial Board Vol.4(2) 2019-09-06T08:34:19+00:00 Umid Kumar Shrestha <p>Not available.</p> 2019-09-05T06:07:44+00:00 ##submission.copyrightStatement## Etiology of isolated terminal ileal ulcers in symptomatic patients 2019-09-06T08:34:19+00:00 Suresh Thapa Binod Karki Dibas Khadka Sanjit Karki Roshan Shrestha Jiwan Thapa Shankar Baral Bhuwneshwer Yadav Ramila Shrestha Bidhan Nidhi Poudel <p><strong>Introduction: </strong>Isolated terminal ileal ulcers (ITIUs) are being frequently encountered by the clinicians with the increasing numbers of ileal intubation during colonoscopies. This study was aimed at finding the etiologies of these ulcers in symptomatic patients and their association with various clinical features.</p> <p><strong>Methods: </strong>This was a hospital based prospective, observational, descriptive study performed on all consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 July 2018 and 30 June 2019. Clinical, endoscopic and histopathological findings were analyzed to determine the etiology of ITIUs in symptomatic patients. Statistical analysis was done by SPSS 20.</p> <p><strong>Results: </strong>Among 60 (7.67%) of 782 symptomatic patients who had ITIUs on ileocolonoscopy, specific etiologies were established in 28 (46.67%) of them. Intestinal TB was the most common specific diagnosis, which was seen in 18 (30%) patients. Chronic abdominal pain with or without chronic diarrhea was the most common indication for ileocolonoscopy.</p> <p><strong>Conclusions: </strong>Specific etiologies like tuberculosis, Crohn’s disease, NSAID-induced ulcer and intestinal spirochetosis were seen in 28 (46.67%) of patients with isolated terminal ileal ulcers. The most common clinical features were chronic abdominal pain (65%) and abdominal pain with diarrhea (16.7%). No clinical presentation was significantly associated with any specific etiology, thus emphasizing the need for routine ileal intubation and tissue sampling for histopathological examination in all symptomatic patients undergoing colonoscopy.</p> 2019-09-05T06:27:31+00:00 ##submission.copyrightStatement## Analysis of Factors associated with Revision of Ventriculoperitoneal shunt at National Institute of Neurological and Allied Science, Nepal 2019-09-06T08:34:18+00:00 Nikunja Yogi Suraj Thulung Mayush Bahadur Munakarmi Rachana Nakarmi Dinesh Nath Gongal <p><strong>Introduction: </strong>Ventriculoperitoneal (VP) shunt is the commonest procedure for hydrocephalus. The cases requiring shunt revision is a major obstacle in its management. Various factors have been implicated for failure or revision of shunt like patient’s age, sex, cause of hydrocephalus, duration of surgery. This study aims to analyze the rate of VP shunt revision and various factors associated with it.</p> <p><strong>Methods: </strong>In this study, we analyzed 237 cases aged three months to 75 years, of VP shunt from January 2010-December 2014 with at least one year follow up at National Institute of Neurological and Allied Sciences. We evaluated the rate of VP shunt revision and various factors associated with it. The categorical variables were evaluated by chi-square test. Odds ratio was calculated for each factors at 95% CI.</p> <p><strong>Results: </strong>There were 54 (22.78%) cases having at least one revision within one year of shunt insertion. The odds of revision of shunt was 6.58 times higher when inserted through frontal approach than occipital approach. The external ventricular drain placement prior to shunt surgery had statistically significant association with shunt revision (p=0.02). There was no difference in patients requiring/not requiring shunt revision when compared in terms of age group, gender, various etiologies and side of shunt insertions.</p> <p><strong>Conclusions: </strong>The rate of shunt revision in our study was 22.78% which is comparable to other studies. Frontal approach in VP shunt insertion was associated with increased rate of shunt failure thus requiring revision. Likewise, external ventricular drain placement prior to shunt surgery was associated with increased incidence of revision surgery.</p> 2019-09-05T06:41:42+00:00 ##submission.copyrightStatement## Laparoscopic Needle assisted Repair of Inguinal Hernia in Children in Manipal Teaching Hospital, Pokhara 2019-09-06T08:34:18+00:00 Binod Bade Shrestha Sujan Shrestha <p><strong>Introduction: </strong>There are numerous minimally invasive surgical techniques for repair of congenital inguinal hernia (CIH) in children. We present a unique needle-assisted laparoscopic inguinal hernia repair using 20-gauge intravenous cannula. This study aims to evaluate the safety and feasibility of this technique.</p> <p><strong>Methods: </strong>This prospective descriptive study was conducted in 50 patients; aged 1-13 years; from February 2018 to May 2019; either admitted with the diagnosis of CIH or detected incidentally when operated for some other surgical conditions. CIH was repaired using single supraumbilical port and 2-0 prolene suture passed through 20-gauge intravenous cannula. Statistical analysis was done using SPSS 20.</p> <p><strong>Results: </strong>A total of 56 hernias were repaired in 50 patients out of which five cases were detected incidentally on patients undergoing laparoscopic appendectomy. The bilateral CIH was present in six cases. The mean operative time was 18.20 ± 4.57 minutes; 17.36 ± 3.83 minutes for unilateral hernia and 24.33 ± 5.20 minutes for bilateral hernia. There was no difference in operative time when compared between gender (p=0.26). The complications were recurrence in 1(1.78%) case, hematoma around deep ring in 2 (3.57%) cases and puncture site bleeding in 2 (3.57%) cases. There were 35 (70%) male and 15 (30%) female. The contralateral occult hernias were noted in 5 (10%) cases.</p> <p><strong>Conclusions: </strong>Single port laparoscopic repair of inguinal hernia using a 20-gauge intravenous cannula with non-absorbable suture is a safe, effective and feasible in resource poor settings. The postoperative complications are minimal which is similar to past studies.</p> 2019-09-05T07:01:50+00:00 ##submission.copyrightStatement## Factors affecting Mortality in Neurosurgical ICU of Manipal Teaching Hospital, Pokhara, Nepal 2019-09-06T08:34:18+00:00 Balgopal Karmacharya Nikunj Yogi Paribartan Baral <p><strong>Introduction: </strong>Mortality is an important self-assessment tool in medical practice. This study assesses various factors associated with mortality in Neurosurgery ICU (NS-ICU).</p> <p><strong>Methods: </strong>A prospective, cross-sectional study was carried out from January 2017 to December 2017 in 416 patients admitted to NS-ICU. The age, sex, diagnosis, GCS, pupil’s abnormality, vital parameters, laboratory parameters, comorbidities were compared in between mortality and survival group. The individual component of GCS was further evaluated.</p> <p><strong>Results: </strong>Out of 416 patients, 374 (89.90%) patients were in survival group and 42 (10.10%) patients in mortality group. Trauma 188(45.20%) and Cerebrovascular accident 133(31.97%) were commonest diagnosis on admission. The GCS, eye-opening and motor component of GCS, abnormal pupils, hypertension (HTN), diabetes mellitus (DM), diastolic blood pressure (DBP), heart rate (HR), operated cases and serum urea levels were found to have significant difference between mortality and survival group. These parameters were further subjected to binary logistic regression which showed DBP (B-0.01, p=0.00), HR (B0.02, p=0.00), motor score of GCS (B-0.50, p=0.04), operated cases (B 1.13,p=0.00), abnormal pupils (B1.85,p=0.00), DM (B1.56, p=0.00) to have significant association with mortality.</p> <p><strong>Conclusions: </strong>High heart rate, low diastolic BP, low motor score of Glasgow Coma Scale, abnormal pupils, diabetes mellitus and operated cases were found to be significantly associated with mortality.</p> 2019-09-05T07:16:39+00:00 ##submission.copyrightStatement## Creutzfeldt-Jackob disease: A Case Report with MRI (DWI) Findings 2019-09-06T08:34:18+00:00 Hari Om Joshi Tong Dan Ting Tang Yuan Ajit Thapa Jyotsna Shakya <p>Transmissible Spongiform Encephalopathy is sub-acute transmissible neurodegenerative disease which affects both human and animals. Among those that affect humans, Creutzfeldt- Jakob disease is the most common. This disease has a genetic basis and characteristic of an infectious disease. Magnetic Resonance Imaging is an important tool in diagnosis of Creutzfeldt-Jakob disease and can assist especially in the early stages of the disease, when the clinical features might not be typical and Electroencephalogram shows normal or nonspecific abnormalities. Newer Magnetic Resonance Imaging techniques such as Diffusion Weighted Imaging have shown to be more sensitive in detecting this disease at its early stage. We report a single case of probable Creutzfeldt-Jakob disease and its peculiar findings on brain magnetic resonance imaging.</p> 2019-09-05T07:50:24+00:00 ##submission.copyrightStatement##