Birat Journal of Health Sciences 2019-09-05T08:50:55+00:00 Professor Dr. Hem Sagar Rimal Open Journal Systems <p>Official journal of Birat Medical College and Teaching Hospital.</p> <p>Author submissions should be made on the journal's own website <a title="BJHS" href="" target="_blank" rel="noopener"></a></p> Is There Socrates without Plato? 2019-09-05T08:50:29+00:00 Kalil G. Abdullah Elliott D. Kozin <p>Not applicable.</p> 2019-09-04T06:30:32+00:00 ##submission.copyrightStatement## Evaluation of Lower Urinary Tract Symptoms (LUTS): Severity Score and Symptom Association 2019-09-05T08:50:30+00:00 Tarun Pradhan Baburam Dixit Thapa Pritha Basnet Surya Prasad Rimal Tulasha Basnet Mohan Chandra Regmi <p><strong>Introduction: </strong>Lower urinary tract symptoms (LUTS) is a group of symptoms relating to stages of micturation such as storage symptoms, voiding dysfunction and post micturation dysfunction. Overactive bladder symptom score (OABSS) is a questionnaires with scores which helps in evaluating the severity of symptoms.</p> <p><strong>Objectives </strong>To find the incidence of women visiting with LUTS and to evaluate storage symptoms in LUTS (urgency, urge incontinence, frequency) using OABSS (overactive bladder symptom score) questionnaires.</p> <p><strong>Methodology </strong>This is a prospective study done from February 2016 to February 2017. Patients visiting Department of Obstetrics and Gynaecology with lower urinary tract symptoms (LUTS) were enrolled in the study after informed consent. Patients were assessed for types of LUTS and data were filled in the performa. If patients had urgency, urge incontinence, increased day time frequency, then the patients were explained and asked overactive bladder symptom score questionnaire (OABSS) and noted. Patients were then examined for pelvic floor dysfunction and neurological abnormalities for identifying association with the symptoms. Statistical analysis was done using SPSS 11.5.</p> <p><strong>Results </strong>Fifty-seven patients were enrolled with lower urinary tract symptoms (LUTS) during study period. Forty-six patients had overactive bladder symptoms (OABS). LUTS were found in age ranging from 21 to 80 years. Majority of patients visiting out-patient department with LUTS were found to have urgency, urge incontinence, increased day time frequency, nocturia. Patients with urgency and urge incontinence showed significant correlation with increasing likert score of OABSS (p&lt;0.05). But the increased day time frequency did not show any correlation with increasing score. The score showed significant correlation with combination of symptoms (urgency, urge incontinence and increased frequency) than patients presenting with single symptom.</p> <p><strong>Conclusion </strong>Diagnosis of LUTS with valid assessment tools and treatment benefits patients with chronic urinary symptoms and also helps clinicians to further re-assess the treatment.</p> 2019-09-04T06:35:38+00:00 ##submission.copyrightStatement## Glaucoma in Community: An Opportunistic Screening in Cataract Screening Programs 2019-09-05T08:50:33+00:00 Lily Rajbanshi <p><strong>Introduction: </strong>Glaucoma is an optic neuropathy for which elevated intraocular pressure is considered as major risk factor. Glaucoma is the second most common cause of blindness after cataract. Since visual loss in glaucoma is irreversible, management strategies must be focused upon early detection and prevention of disease progression through strict control of intraocular pressure.</p> <p><strong>Objectives: </strong>To estimate the ocular morbidity of glaucoma in community screening camps and to estimate the types of glaucoma<strong>.</strong></p> <p><strong>Methodology: </strong>It is a Community based opportunistic screening program. Study was carried out at community screening camps for cataract from August 2009 to August 2010. Five hundred five patients equal and above 50 years were examined in five screening camps conducted in Kathmandu valley. Glaucoma suspects were identified on the basis of shallow anterior chamber, intraocular pressure &gt; 20 mm of Hg, abnormal frequency doubling perimetry (FDP), cup to disc ratio (CDR) &gt;0.7:1, asymmetric CDR &gt; 0.2:1, unhealthy NRR and the other disc findings suggestive of glaucoma. Glaucoma suspects were re-examined in tertiary eye hospital (TIO) in order to make a final diagnosis and provide treatment<strong>.</strong></p> <p><strong>Result: </strong>Out of 505, 67 glaucoma suspects were re-examined in Tilganga Institute of Ophthalmology. Number of patient diagnosed glaucoma was 17 (3.37%). Of them 9 patients (1.78%) had POAG, 4 (0.79 %) had secondary glaucoma, 3 (0.59%) had normal tension glaucoma and 1 (0.20 %) had ocular hypertension.</p> <p><strong>Conclusion: </strong>Morbidity of glaucoma is very high in community and more screenings in larger scales are needed in order to decrease the burden of blindness due to glaucoma.</p> 2019-09-04T06:37:08+00:00 ##submission.copyrightStatement## Pattern of Occurrence of Ocular Injuries and their Forensic Aspects 2019-09-05T08:50:35+00:00 Sidarth Timsinha Suvarna Manjari Kar Malshree Ranjeetkar <p><strong>Introduction: </strong>All penetrating or non-penetrating intentional ocular trauma causing loss of an organ or part of an organ and which have as a consequence the facial disfigurement or post trauma sequelae formation have forensic implications.</p> <p><strong>Objectives: </strong>To study the pattern of ocular injuries its forensic implications and meticulous documentation in ocular medicolegal cases.</p> <p><strong>Methodology: </strong>This hospital based cross sectional study was carried out by Forensic medicine personnel in Department of Ophthalmology and Emergency Department of Manipal Teaching Hospital Pokhara, Nepal. A total of 251 cases of ocular injury constituted the sample size. Cases were analyzed according to age, sex, type of trauma, causative agent, and manner of injury and ocular injuries having any medicolegal value. All data was evaluated and relevant information were extracted and entered into a database.</p> <p><strong>Results: </strong>Male subjects 174 (69.32%) were more susceptible to ocular injuries and age group 21-30 years 66 (26.3%) were more predisposed to ocular injuries. The commonest cause of ocular trauma was due to fall on blunt objects 42(16.73%). The most common site of injury was cornea 120(47.81%) and corneal abrasion 65(54.16) was the most common ocular finding. Accidental manner of injury was observed in majority of the cases 230 (91.60%). Ocular injuries sustained were all simple in nature 251(100%) as a result no fatality was observed following ocular injury.</p> <p><strong>Conclusion: </strong>Proper history taking and methodical documentation of injuries not only assist in diagnosis and management of the patient but also holds an evidentiary value in medico legal cases.</p> 2019-09-04T06:38:16+00:00 ##submission.copyrightStatement## Risk Factors and Outcome of Instrumental Vaginal Delivery in BP Koirala Institute of Health Sciences 2019-09-05T08:50:38+00:00 Baburam Dixit Tara Manandhar Sarita Sitaula Tulasa Basnet 2019-09-04T06:39:32+00:00 ##submission.copyrightStatement## Knowledge, Attitude and Practice of Care Givers with Children Under Five Years of Age about Vaccination in Sunsari District, Nepal 2019-09-05T08:50:39+00:00 Parth Guragain Hem Sagar Rimal Tara Kumari Kafle <p><strong>Introduction: </strong>Immunization has shown major preventive aspects of infectious diseases, disability and death. Care giver is a person who provides direct care for children, elder people and chronically ill.</p> <p><strong>Objectives: </strong>To assess the Knowledge, Attitude and Practice (KAP) of caregivers in Sunsari district about vaccination of under five children brought for vaccination at different private and government vaccination centers.</p> <p><strong>Methodology: </strong>It is a cross sectional study that was carried out among 100 care givers from different places of Sunsari district for 3 months. The care givers completed a semi structured questionnaire that contains 4 different parts about the demographics, knowledge, attitude and practice of care givers toward immunization.</p> <p><strong>Results: </strong>Most of the care givers have high level of awareness and importance of vaccination, which shows positive attitude and practice. The overall KAP was good among most of the caregivers (87.2%). The higher KAP level was positive associated with female gender, higher educational degree and having higher number of children.</p> <p><strong>Conclusion: </strong>Most of caregivers from three different places of Sunsari districts had good KAP (in sense that most of the caregivers have awareness for quality and basic health standard) towards immunization which was associated with female gender and higher educational degrees. However, educational programs like community awareness and mobilizing Female Community Health Volunteers for providing appropriate knowledge of vaccination which increases the caregivers' knowledge, which might have change cognitive behavior. This study reflects the overall knowledge of caregivers towards immunization process which is very essential in childhood for prospective healthy future of the child.</p> 2019-09-04T07:03:47+00:00 ##submission.copyrightStatement## Prediction of Stature Based on Foot Length In Medical Students of Birat Medical College & Teaching Hospital, Morang, Nepal 2019-09-05T08:50:40+00:00 Umesh Kumar Mehta Arun Dhakal Surya B. Parajuli Sanjib Kumar Shah <p><strong>Introduction: </strong>Stature is one of the most important anatomical parameters for personal identification. Estimation of stature by measuring different parts of the body is valuable in medico legal investigations as well as in anthropology.</p> <p><strong>Objectives: </strong>The objective of this study was to find correlation between stature and foot length and developing a regression equation for stature estimation from foot length among medical students of Birat Medical College &amp; Teaching Hospital, Morang, Nepal.</p> <p><strong>Methodology: </strong>This is cross sectional study conducted at Department of Anatomy of Birat Medical College &amp; Teaching Hospital, Morang, Nepal from 15 March 2019 to 15 June 2019. Two hundred (100 male and 100 female) medical students were enrolled in the study. Stature and foot length were measured using standard instruments. The collected data was entered into Microsoft excel and analyzed by using SPSS.</p> <p><strong>Results: </strong>The mean stature in male was 165.4 cm with SD of 8.46 cm, in female the mean stature was 156.5 cm and with SD 6.56 cm. The mean foot length in male was 25.84 cm with SD of 1.73 cm, in female mean foot length was 23.35 cm with SD 1.30 cm. This gender wise difference in mean stature and foot length between males and females was statistically significant (p&lt;0.001). There was significant positive correlation between stature and foot length (r = 0.534, P &lt; 0.001) for male and (r=0.675, P &lt; 0.001) for female. Regression equations were derived for estimation of stature from measurement of foot length in both sexes.</p> <p><strong>Conclusion: </strong>This research found significant positive correlation between stature and foot length in both sexes. Regression equation was also derived which help to predict the stature by knowing the foot length in medico legal cases.</p> 2019-09-04T07:05:00+00:00 ##submission.copyrightStatement## Behavioral Problems among School Going Adolescents in Eastern Development Region of Nepal 2019-09-05T08:50:41+00:00 Tara Kumari Kafle Tika Kumari Kafle Saidur Mashreky Hem Sagar Rimal Durga Sapkota Archana Pokhrel <p><strong>Introduction: </strong>The public health relevance of mental health conditions including behavioural problems in children and adolescents has been a growing concern over the past decades. There are negligible studies found in mental health domains of adolescents in developing countries; studies with regional or national coverage are lacking in Nepal. Therefore, present study has been designed to explore the magnitude and risk factors of behavioral disorders among adolescents.</p> <p><strong>Objective: </strong>The objective of this study is to examine the prevalence of behavioral disorders and its determinants among school going adolescence in Eastern Development Region of Nepal.</p> <p><strong>Methodology: </strong>The study adopts analytical cross-sectional design with sample size 1500 involving 11 to 17 year school going adolescents and carried out in Eastern Development Region of Nepal during August to December 2016. Multistage probability sampling technique was used to draw the sample and validated self-report SDQ was used to estimate the behavioral problems. Ethical approval was taken from ERB of Nepal Health Research Council. Written informed consent was taken from each participant before collecting the information. Collected information were entered using Epi Data software and processed to SPSS version 16 for analysis. Both bivariate and multivariate analysis were carried out.</p> <p><strong>Results: </strong>The prevalence of total (overall) behavioral problem was found among 35.0 % adolescents. While classifying, 13.3% were suffering from emotional disorder, 11.20% from conduct problem, 7.2% from hyperactivity/inattention, 4.9% from peer relationship problem and 2.1% from prosocial activities. In multivariate analysis, female adolescents, adolescents of uneducated or less educated parents (less than 10+2), residing in mountain ecological belt and adolescents without parents (dead or separated) were found positively associated with behavioral disorders.</p> <p><strong>Conclusion: </strong>Total behavioral problem was found among 35.0% adolescents. adolecents of less educated parents, female sex, Mountain ecological belt and those without parents were more vulnerable to behavioral problem. Therefore, parental care seems to be very much essential to reduce the behavioural problems among children.</p> 2019-09-04T07:06:25+00:00 ##submission.copyrightStatement## Communication Difficulties and Psychological Stress in Patients Receiving Mechanical Ventilation 2019-09-05T08:50:43+00:00 Dejina Thapa Anika Dahal Rameshwari Singh <p><strong>Introduction: </strong>Communication is fundamental for an individual to verbalize their feelings. Inability of the patient receiving mechanical ventilation to communicate the needs to the health care provider often leads to psychological stress.</p> <p><strong>Objective: </strong>The objective of the study is to assess the communication difficulties and psychological stress in patients receiving mechanical ventilation.</p> <p><strong>Methodology: </strong>A cross-sectional research design was used for the study. A total of 48 patient extubated within the preceding 72 hours, was taken as a sample by using a convenience sampling method. Data were collected by using a interview technique in patients from January–September 2018 from a 41- bedded ICU at Nobel Medical College Teaching Hospital. Data analysis was done by descriptive and inferential statistics.</p> <p><strong>Results: </strong>Difficulty in communication was found where majority of the respondents (82.29%) rated general communication as extremely hard. The study further revealed that 100% of the respondents used hands for pointing and gesturing followed by shaking heads (65.38%), whisper (19.23%) and writing (11.53%). Sleeping and communication difficulty was the major problem 97.91% and 96.94% respectively. Majority of respondents (66.66%) scored Intensive Care Psychological Assessment Tool more than 7. In addition, there is significant association between the sex, total length of ventilation and prior experience with ICU (p= &lt;0.05).</p> <p><strong>Conclusion: </strong>Patient with mechanical ventilation experience a moderate to extreme level of psychological stress because they have difficulty in communicating their needs. Alternative communication methods should be developed, and health care provider should be aware about the communication difficulties, thereby reducing the stress caused by ineffective communication.</p> 2019-09-04T07:07:39+00:00 ##submission.copyrightStatement## A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety 2019-09-05T08:50:45+00:00 Sabin Gauchan Chitra Thapa Abha Prasai <p><strong>Introduction: </strong>Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist.</p> <p><strong>Objective: </strong>The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia.</p> <p><strong>Methodology: </strong>120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups.</p> <p><strong>Results: </strong>There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication.</p> <p><strong>Conclusions: </strong>Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.</p> 2019-09-04T07:08:38+00:00 ##submission.copyrightStatement## Morphometric Evaluation of Dry Humerus Bone in a Medical College of Eastern Nepal 2019-09-05T08:50:47+00:00 Raju Kumar Chaudhary Arun Dhakal Sanjib Kumar Sah Surya B Prajuli Suman Pokhrel Santosh Kumar Deo <p><strong>Introduction: </strong>Anthropometric measurement of dry bones are helpful to estimate the stature. It is useful for differentiating unidentified bodies, skeletal remains, surgical procedures and are helpful for anthropologists, anatomists, forensic and surgery.</p> <p><strong>Objective: </strong>The objective of this study was to find the morphometric measurements of dry Humerus bone available at Birat Medical College and Teaching Hospital of Eastern Nepal.</p> <p><strong>Methodology: </strong>A cross- sectional study was conducted from 28th June- 28th July 2019 in the department of Anatomy of Birat Medical College and Teaching Hospital by taking 59 dry humerus bone. Various parameters such as maximum length, circumference of surgical neck, epicondylar breadth together with position and number of nutrient foramina were measured. Data was collected using osteometric board, vernier caliper and tape. The number, direction and location of nutrient foramina were observed macroscopically by using a fine wire. Ethical clearance was taken from Institutional Review Committee of Birat Medical College and Teaching Hospital.</p> <p><strong>Results: </strong>Among 59 dry humerus bone, majority (32) were left humerus. No statistical significant difference was found in morphometric measurements between right and left side of dry Humerus bone. The single nutrient foramen was present in 85.18% and 81.25% of right and left humeri respectively. Double nutrient foramina in 14.81% of right humeri and 15.62% of left humeri. Triple nutrient foramina was only seen in left humeri (3.12%).</p> <p><strong>Conclusion: </strong>Single nutrient foramen is most common in both sides of humeri. No statistical significant difference was found between right and left humeri in the different parameters such as maximum humeral length (MHL), vertical diameter of superior articular surface (VDSAS), circumference of surgical neck (CSN), circumferences of middle shaft (CMS), epicondylar breath (EB), medial epicondyle to capitulum (ME - C), transverse diameter inferior articular surface (TDIAS), maximum transverse diameter of trochlea (MTDT), anteroposterior diameter of the trochlea (APDT) and position of nutrient foramina (PNF).</p> <p><strong>&nbsp;</strong></p> 2019-09-04T07:09:37+00:00 ##submission.copyrightStatement## Spectrum of Exfoliative Cytology at Birat Medical College and Teaching Hospital 2019-09-05T08:50:49+00:00 Shilpi Shaukin Satosh U Kafle Mrinalini Singh <p><strong>Introduction: </strong>Exfoliative cytological study of body fluids is easy, simple, rapid, cost effective and patient compliant investigation that helps in characterizing the disease into their varying subtypes. These presumptive and sometimes definitive diagnoses are in most cases the cornerstone which helps in staging and prognosis of the patient</p> <p><strong>Objective: </strong>To determine the spectrum of malignant and non-malignant lesions in exfoliative cytology</p> <p><strong>Methodology: </strong>This was a quantitative retrospective cross sectional study conducted at Birat Medical College Teaching Hospital from 24th December 2014 to 24th December 2018. All the exfoliative samples received at the lab were accepted in our study.</p> <p><strong>Results: </strong>Of the 300 samples received, the maximum number were those of sputum followed by pleural fluid and ascitic fluid. Peritoneal fluid, Cerebrospinal fluid, synovial fluid, fluid from suspected abscess and breast fluid were also received. Malignancy was found in 1.67% of the samples studies.</p> <p><strong>Conclusion: </strong>A study of different cytomorphological features of exfoliative cytology samples will help in establishing the role of cytology as an important diagnostic tool in improving the effectiveness of diagnosis , treatment &amp; prognosis of the patient in the medical field.</p> <p><strong>&nbsp;</strong></p> 2019-09-04T07:10:41+00:00 ##submission.copyrightStatement## Validation of Hadlock's and Shepard Formulae of Fetal Weight Estimation in Eastern Region of Nepal 2019-09-05T08:50:51+00:00 Roshana Khadka <p><strong>Introduction: </strong>Ultrasonography plays a pivotal role in present day obstetrics. It has been well recognized that the fetuses of extremes of the normal birth weight range are associated with increased perinatal morbidity, mortality and adverse development outcomes. Categorization of fetal weight into either the small or large for gestational age may lead to timed obstetric interventions that collectively represent significant departure from routine antenatal care.</p> <p><strong>Objective: </strong>To compare the accuracy of Hadlock's 1, 2, 3, 4 and Shepard model in estimating expected fetal weight and its comparison with actual birth weight in our population at eastern region of Nepal.</p> <p><strong>Methodology </strong>A prospective observational study was performed in the Department of Radiodiagnosis, Nobel Medical college and teaching hospital, Biratnagar, over a period of 6 months dated Jan 2018 to June 2018 using systematic random sampling with sample size estimated as 160, with 5% level of significance, 80% power of test and a maximum of 200 grams differences by our predicting model from actual mean weight. Singleton, term pregnancy (37- 42 weeks gestational age) verified with antenatal USG performed prior to 20 weeks' gestation. Pregnancies complicated by congenital anomalies and deliveries after 2 days of USG examination were excluded.</p> <p><strong>Results: </strong>159 pregnant ladies were enrolled in our study with mean age of 27.60 ± 5.633 years (range 18-43 years). The average (actual) birth weight recorded was 3450.79±438.73gms. The different formulae for estimating birth weight gave us similar results. Estimation of fetal weight by Shepard gave us a mean of 3340.80 ± 463.72. Hadlock1, Hadlock2, Hadlock3 and Hadlock4were 3546.55±429.92grams, 3491.18±439.49 grams, 3445.23 ±422.79grams, and 3446.12±418.43grams respectively.</p> <p><strong>Conclusion: </strong>All four Hadlock formulae gave comparable results for fetal weight estimation including the Shepard formula; however, Shepard formula tends to underestimate fetal weight as compared to rest of the formulae. Among the Hadlock's, Hadlock 2 seems to show betier accuracy in fetal weight prediction in our population of study. The mean birth weight recorded using Hadlock 1 formula gave the beer correlation with the actual birth weight though the difference between four Hadlock formulae was all insignificant.</p> 2019-09-04T07:11:42+00:00 ##submission.copyrightStatement## Spectrum of Unnatural Deaths in Palpa, Nepal: Autopsy Based Study 2019-09-05T08:50:52+00:00 Alok Atreya Samata Nepal Pushpa Raj Gyawali <p><strong>Introduction: </strong>Analysis of unnatural death of a community reflects the cause of death and socio-economic strata of that society. Medico-legal autopsies are conducted under the ordinance of legal authority in all cases of unnatural deaths.</p> <p><strong>Objectives: </strong>The present study is aimed to determine the spectrum of unnatural deaths in Tansen Municipality of Papla district of Province 5, Nepal.</p> <p><strong>Methodology: </strong>This autopsy based study was conducted during the Nepalese fiscal calendar 2074/75 which includes all the cases autopsied in the mortuary of District Hospital Tansen, Palpa.</p> <p><strong>Results: </strong>Of total 184 medico-legal autopsies road traffic accidents (RTA) was the leading cause of death (n=53, 28.8%) followed by hanging (n=43, 23.41%) and burn (n=33, 17.9%). Of the 33 cases of burn 25 were females (13.6%) and 8 males (4.3%). There were 13 cases (7.1%) of obscure autopsy.</p> <p><strong>Conclusion: </strong>The present study reflected the spectrum of unnatural deaths in Palpa district of province 5, Nepal which revealed RTA as a leading cause of death, followed by hanging. When gender was taken into account it was revealed that more females succumbed to death due to complications of the burn injuries sustained. Unnatural death due to fatal poisoning was least common finding of the present study although poisoning is one of the leading causes of deliberate self-harm globally. Proposal/program of collaboration of District Hospital with other tertiary care centres of Palpa district is the need of the hour which would provide specific, timely and expert approach to range of medicolegal cases.</p> <p><strong>&nbsp;</strong></p> 2019-09-04T07:12:40+00:00 ##submission.copyrightStatement## Head Injury in Nepal: An Institutional Based Prospective Study on Clinical Profile, Management and Early Outcome of Traumatic Brain Injury in Eastern Part of Nepal 2019-09-05T08:50:53+00:00 Prakash Kafle Babita Khanal Dipak Kumar Yadav Deepak Poudel Tejendra Karki Iype Cherian <p><strong>Introduction: </strong>Traumatic brain injuries (TBI) are among the worst consequences and are the major causes of death and disability worldwide. It is considered as silent epidemics affecting individuals of all the ages and one of the major burden of neorological disease. Hence, TBIs are often overlooked and are sometimes called “the neglected disease of modern society”. Presenting GCS is the best predictor of outcome.</p> <p><strong>Objective: </strong>The present study aims to portray the epidemiology, clinical profile, its management, early outcome and to evaluate the outcome predictors in a tertiary care center in eastern part of Nepal.</p> <p><strong>Methodology: </strong>This is a prospective cross-sectional study conducted at the Department of Neurosurgery, Nobel Medical College Teaching Hospital, Biratnagar, Nepal over the period of 1 year (October, 2016 - December 2017). The primary objective of this study was to review the etiology, clinical profile and early outcome of patients with TBI.</p> <p><strong>Results: </strong>During the study period, 1056 patients with head injuries were studied. Of these 202 cases required surgical intervention and 32 were excluded. Mean age of the study population was 38.7 years with the male to female ratio of 3.49:1. Road traffic accident was the most common cause of TBI (76%). Overall mortality rate was 11.17%. Unfavorable GOS at discharge was 43.5% and 26.1% at three months follow-up.</p> <p><strong>Conclusion: </strong>TBI continues to be a significant burden of neurosurgical care in major neurosurgical centers in Nepal. This study contributes data on the etiology and clinical profile of patients with TBI from tertiary care center of Nepal.</p> 2019-09-04T07:14:35+00:00 ##submission.copyrightStatement## Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section 2019-09-05T08:50:55+00:00 Roshan Pradhan Seema Kumari Mishra Lalit Kumar Rajbanshi Kanak Khanal Batsalya Arjyal Hanoon P Pokharel <p><strong>Introduction: </strong>Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption.</p> <p><strong>Objective: </strong>To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section.</p> <p><strong>Methodology: </strong>This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively.</p> <p><strong>Results: </strong>Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.</p> <p>&nbsp;<strong>Conclusion: </strong>The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.</p> 2019-09-04T07:16:16+00:00 ##submission.copyrightStatement## A Vitreous Cyst in an Elderly: A Rare Case Report 2019-09-05T08:50:32+00:00 Anadi Khatri Amrit Banstola Pratap Karki <p>This condition has been seen to occur in younger patients. We report here a case of a 54-year - old woman with vitreous cyst.</p> 2019-09-04T07:17:44+00:00 ##submission.copyrightStatement## Polymyxin B and Doxycycline for Treatment of Multidrug Resistant Klebsiella Pneumoniae and Staphylococcus Aureus Pneumonia in Intensive Care Unit 2019-09-05T08:50:34+00:00 Niraj Kumar Keyal Manish Nakarmi Pooja Adhikari <p>Doxycycline is a broad spectrum antibiotic. We hereby report a case report of patients that developed multidrug resistant hospital acquired pneumonia. Patients were treated with Polymyxin B and Doxycycline. From this we want to emphasize that Doxycycline can be used as alternative agent in combination with Polymyxin B for treatment of multidrug resistant pneumonia although there are no large scale studies on combination of Polymyxin B and Doxycycline.</p> 2019-09-04T07:18:49+00:00 ##submission.copyrightStatement## Appendicitis in the Elderly Patient with Multiple Co-Morbid Conditions: Case Report 2019-09-05T08:50:36+00:00 Anuj Jung Rayamajhi Prashanta Paudel Rupesh Kumar Yadav Subash Chandra Paudel Bidur Kumar Dhungel Bikram Byanjankar Rabin Pandit <p>Acute appendicitis is commonly encountered surgical emergency worldwide.&nbsp; Although, it is commonly found in young and middle aged groups, the incidence of the diseases in geriatric age group is very rare and possesses a great challenge to safe technique of anesthesia due to co-existing comorbid conditions and medications used. Geriatric population are more susceptible to complications of appendicitis. This is a case report of 82 years old male patient, presented with appendicular perforation with localized abscess formation in a septic state with multiple comorbid condition. Routinely performed Spinal and general anaesthesia adds further challenge in management of this patient during and after surgery. Therefore, we performed the case in regional nerve block; paravertebral, ilioinguinal- iliohypogastric (ILIH) and coeliac plexus block and sedation.</p> 2019-09-04T07:19:33+00:00 ##submission.copyrightStatement##