Birat Journal of Health Sciences

Public or Private/Home: Where and Why are Ill Neonates Sought out for Health Care?

Kamal Bahadur Budha — 2022-12-31

Introduction: Care seeking behavior is a process of taking actions in the pursuit of health gain and obtaining treatment. Various factors influence mothers to choose public or private health care facilities for neonatal health and illness, which may help policy makers to achieve the Universal Health Coverage (UHC).

Objective: The study aimed to find out the factors associated with maternal care-seeking behaviors of their neonates’ health and illness.

Methodology: A cross-sectional study was carried out among 248 mothers having neonates up to six months with the history of illness during their neonatal period, selected by applying 30 cluster sampling strategy. We entered data and then analyzed in SPSS with chi-square test and logistic regression methods.

Results: Majority of ill neonates (68%) were sought out in public health facilities in Jumla. A few (6%) were taken to private facilities whereas more than one-fourth (28%) were either sought out nowhere or treated at home traditionally. Proportion of fever and acute respiratory infections (ARI) among neonates was almost half (46.4%) and one-fifth (19%), respectively. Multivariate logistics regression showed that mothers with primary education and above had an odds of 25 (95% CI, 1.44-333.0) , with a self-decision had an odds of 11.29 (95% CI, 2.26-56.00), and walking distance of ≤30 minutes to health facility had an odds of 104.2 (95% CI, 3.80-2821.4), for seeking out the remedy in public health facilities for their neonates.

Conclusions: The study concluded that more than half neonates were ill from different diseases and more than two-thirds of them were taken to public health facilities to seek out for remedy. Maternal education having at least primary level, with a self-decision, and less distance to health facilities were the probable factors of choosing public health facilities for seeking out the remedy for a neonatal illness. Nonetheless, further studies with larger sample size and stronger designs are warranted for a firmer conclusion.

Change in Contrast Sensitivity among Patients with Diabetic Mellitus Type II

Sabina Shrestha — 2022-12-31

Introduction: Eye being one of the target organs of diabetes mellitus has many pathological consequences, one possibly being contrast sensitivity. Contrast sensitivity is required for daily activities like in situations of low light, fog or driving at night. The study was conducted to find out contrast sensitivity among diabetic

Methodology: A hospital based descriptive cross- sectional study of contrast sensitivity was conducted among type II diabetics with or without retinopathy at Kathmandu Medical College from April to December 2018. Patient demographics and comprehensive clinical examinations findings were recorded in a specially designed proforma. Convenience sampling was done and informed consent was taken.

Leas symbol low contrast test 10M was used for contrast sensitivity testing. The contrast levels of the test lines on the five pages are 25%, 10%, 5%. 2.5%and 1.2%. Data was analyzed in excel and SPSS (version21). Results were expressed in frequency, percentage and mean as required. Association of contrast sensitivity with age, gender, duration of diabetes, blood sugar level and diabetic retinopathy was tested using chi square test.

Results: Among the 45 study population, female to male ratio was 1:2. Age ranged from 25 to 76 years with maximum patients in the age group 51-60 years. Blood sugar was controlled in 33.33%. Contrast sensitivity was decreased in 40%. Among the patients with decreased contrast sensitivity, blood sugar was uncontrolled in 66.67%. Similarly, 72.2% of participants with decreased contrast sensitivity had no diabetic retinopathy. The association of contrast sensitivity with age of the patient, gender, duration of diabetes mellitus, blood sugar level and diabetic retinopathy was not statistically significant with p values 0.34, 0.52, 0.07, 1 and 0.89 respectively.

Conclusion: Contrast sensitivity can be decreased among patients with type II diabetes mellitus irrespective of gender, age of the patient, duration of diabetes, control of blood sugar and presence or absence of diabetic retinopathy.

Relation of Antral Follicular Count and Follicular Stimulating Hormone with Anti-Mullerian Hormone in Determining Ovarian Reserve in Infertile Women Presenting in a Tertiary Health Centre of Nepal

Bhuwan Prasad Ojha — 2022-12-31

Introduction: Infertility is a disorder of the reproductive system defined by failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Globally, about 10-15% married couples are sub-fertile. 20-40% of female factors for infertility include ovarian cause. Ovarian reserve refers to the size of resting primordial follicle in the ovaries which determines the capacity of the ovary to provide egg cells for fertilization resulting in a successful pregnancy. Ovarian reserve is one of the most reliable investigations to determine ovarian regression, which regresses with age. Follicular Stimulating Hormone (FSH), Estradiol (E2), Antral Follicular Count (AFC) and Anti-Mullerian Hormone (AMH) are investigations to determine ovarian reserve.

Objective: To determine the correlation of antral follicular count and follicular stimulating hormone with anti-mullerian hormone in determining ovarian reserve among infertile women attending infertility clinic of Tribhuvan University Teaching Hospital (TUTH).

Methodology: This was a prospective, hospital based study conducted among 78 patients attending infertility clinic in the Department of Obstetrics and Gynecology at TUTH, Kathmandu from 14^th April 2017 to 13^th April 2018. After taking history and examination, routine infertility investigation was sent. On the Day 2 or Day 3 of the cycle, serum FSH and AMH were sent. On the 3-5 day of the cycle, trans-vaginal scan was done for antral follicular count. Follicular monitoring was done every alternate day from day 9 of natural cycle till the follicle became 18 to 22 mm. If no follicle developed even after day 20 of menstruation, monitoring was stopped and development of follicle or failure was noted. This monitoring was done in single cycle. Early follicular phase serum FSH, AMH and AFC were correlated in relation to follicular development.

Result: Among 78 patients included, mean age was 27.6 ± 3.14 years. The mean FSH, AMH and total AFC were 6.46 ± 1.90 IU/ml, 5.01 ± 3.46 ng/ml and 15.88 ± 5.21 respectively. A strong positive linear correlation between AFC and AMH (p<0.001, r=0.811) and weakly negative correlation between FSH and AMH (p=0.182, r= -0.153) was found.

Conclusion: Serum AFC level showed a strong positive correlation with AMH and could be used as an alternative to AMH to assess ovarian reserve.

Parental Stress and Coping Mechanisms in Rearing Children with Intellectual Disability: A Study Conducted in Kathmandu

Amrita Shrestha — 2022-12-31

Introduction: The birth of a child with an intellectual disability is the most traumatic event experienced by the parents and their families. The main objective of this study is to identify parental stress and coping in rearing children with intellectual disabilities in Kathmandu valley.

Methodology: A descriptive cross-sectional study was conducted among 222 parents (either mothers or fathers) of children with an intellectual disability visiting nine organizations selected through probability proportionate to size sampling. Data were collected through interview techniques using the Nepali-translated Parental Stress Scale and cope tool developed.

Results: Maximum respondents (76.1%) were mothers with an overall mean age of 46.28±12.73 years. The major stress expressed was anxiety-related to a child's future after parents' death (19.8%) and most used coping measure was sharing feelings (44.6%) were expressed as major stress and coping measures used respectively. The overall mean score of parental stress was 64.58±9.22 and parental coping was 106.45±9.72. Maximum respondents have a moderate level of stress (54.5%) followed by severe stress (43.2%) and a moderate level of coping (86.9%) followed by a maximum level of coping (13.1%). There was a significant association of level of stress with relationship to the child, parent’s education, and presence of co-disability in the intellectually disabled child. There was a significant association of level of coping with parents’ education.

Conclusion: Maximum respondents had a moderate level of stress and a moderate level of coping mechanisms. Parental stress was high in mothers, illiterate parents, and parents having an intellectually disabled child of 17 years or younger. Parental coping was high among Hindu and literate parents.

Impact of Training Program to Nurses Regarding Complementary Feeding in Infant and Young Children: An Educational Interventional Study

Pawana Kayastha — 2022-12-31

Introduction: Under nutrition is an underlying cause of more than one third of global deaths in children below the age of 5 years. Nutrition education is a critical strategy of intervention to improve child complementary feeding practices which will subsequently decrease mortality and morbidity of under-5 children.

Objective: To determine the knowledge of nurses on complementary feeding practices and also provide appropriate training and verify its effectiveness.

Method: It is a hospital based educational interventional study. The time-series was from October 2021 to march 2022 included 24 nursing staff. The nurses underwent one-day training on complementary feeding practices in infant. They were evaluated periodically on their knowledge at four different time points. The effectiveness of training was calculated based on the change in scores, as per mean numeric scores, immediately, 1 and 6 months after the training.

Result: The nurses showed high competence by obtaining above average scores (100%) by all participant immediately after training and remained so after 1 month. The mean test score obtained before training was 15.3 which increased to 23 after training, 21.9 after 1 month and 17.8 after 6 months of training. The differences in mean were statistically significant (p value 0.000).

Conclusion: This training intervention improved knowledge of nurses regarding complementary feeding practices, but improvements need to be strengthened and sustained.

Practice of COVID-19 Preventive Measures and its Associated Factors among the Undergraduate Medical Students: A Cross-Sectional Study

Anjali Mishra — 2022-12-31

Introduction: The COVID-19 is an emerging infectious disease with serious public health consequences. Appropriate practice of preventive measures and adherence to it play an essential role in reducing infection rates and controlling the spread of the disease.

Objectives: This study aimed to assess the practices of COVID-19 preventive measures and its associated factors among the undergraduate medical students at Birat Medical College Teaching Hospital.

Methodology: A cross-sectional study was conducted from 25 July 2021 to 25 December 2021 among the medical students at Birat Medical College Teaching Hospital, Morang, Nepal. The complete enumeration of 146 medical students were carried out. Ethical clearance was obtained from the Institutional Review Committee at Birat Medical College Teaching Hospital. A semi-structured questionnaire using Google forms was used for data collection. Univariate and bivariate analysis were done. A p-value less than 0.05 was considered statistically significant.

Results: The mean score for practices of preventive measures towards COVID-19 was 16.58±2.73. More than half of the participants (54.1%) adopted good practices. The most frequently performed practice was wearing face masks when going outside the home (98.6%), followed by hand washing using soap and water for at least 20 seconds regularly (96.6%) and covering the mouth when coughing or sneezing with a tissue paper/a disposable handkerchief (96.6%). Moreover, most of the participants used alcohol-based hand sanitizer if soap and water were not available (95.2%), stayed at home when they felt flu-like symptoms (95.2%), visited the nearest health facility when getting sick (95.2%), and avoided close contact with sick individuals with flu-like symptoms (93.2%). Age, gender, ethnicity, religion, marital status, academic year, average monthly family income, any health insurance and vaccination status were not significantly associated with the practice of COVID-19 preventive measures.

Conclusion: More than half of the participants adopted good practices of preventive measures towards COVID-19. Lower practice scores among medical students is the matter of concern.

Comparison of Effects of Volume-Controlled and Pressure-Controlled Ventilation during Laparoscopic Surgeries in Birat Medical College Teaching Hospital

Batsalya Arjyal — 2022-12-31

Introduction: The pneumoperitoneum created during laparoscopic surgery has numerous effects on the patient ranging from respiratory to hemodynamics. The two common methods of ventilator are volume control and pressure control. The volume control method has been commonly used during general anesthesia. Pressure control method has been used in intensive care unit for improving the respiratory mechanics.

Objective: The study aims to compare the effects of pressure control to volume control ventilation in patients undergoing laparoscopic surgery. The hypothesis of the study is that pressure control method improves the respiratory mechanics by decreasing the peak airway pressure and increasing the lung compliance.

Methodology: The total of 100 patients who underwent laparoscopic surgery were undertaken for this study. The 50 in each group (PCV and VCV) were allotted randomly. As per predicted body weight, the tidal volume was adjusted to 8 ml/kg, for both the modes of ventilation, peep 5 mm of Hg with fio2 of 100% and I:E-1:2,. The variations in peak airway pressure, mean airway pressure, lung compliance, SPO2 and hemodynamic parameters were observed at baseline (T1), at pneumoperitoneum (T2), after 10 minutes of pneumoperitonium (T3) and at 20 minutes after pneumoperitonium (T4).

Results: The pressure control group on comparison to volume control mode group showed significant decrease in peak airway pressure while increase in mean airway pressure and increase in lung compliance at different points of pneumoperitoneum. However there was no significant change in hemodynamics between the two groups in patient undergoing laparoscopic surgery.

Conclusion: We conclude that respiratory mechanics improve when the patient is on pressure control ventilation in compared to volume control method of ventilation. Whereas there is no difference in hemodynamic parameters between the two methods.

Menstrual Disorders and its Effects on Academic Performance among the Nursing Students of PUSHS, Gothgaun

Sapana Shrestha — 2022-12-31

Introduction: Menstrual cycle is a periodic physiological process in women of childbearing age. Menstrual disorders may affect the daily activities and quality of life among reproductive age group women worldwide.

Objective: The objective of this study was to find out the menstrual disorders and its effects on academic performance among the nursing students of Purbanchal University School of Health Sciences.

Methodology: It was a descriptive, cross-sectional study conducted among 170 undergraduate nursing students of Purbanchal University School of Health Sciences, Gothgaun. Proportionate followed by simple random sampling (lottery method) was adopted. Data was collected through self administered method using semi structured questionnaire. Statistical analysis was done by descriptive and inferential statistics using SPSS version 16.0. Female with systemic health problems, any diagnosed pelvic pathology (fibroids, pelvic inflammatory disease), positive pregnancy test, and lactating mothers were excluded from the study.

Results: Among 170 respondents, most of them (87.1%) had some form of premenstrual symptoms. Majority of them (77.6%) had dysmenorrhea. There was statistically significant association between dysmenorrhea and academic performance with class absenteeism (p=0.009), lack of concentration in class (p<0.001), not able to prepare for exam (p=0.014), mood swings (p=0.043), difficulty in participating in extracurricular activities and difficulty in public speaking (p=0.007). Premenstrual syndrome was also significantly associated with class absenteeism (p=0.012), sleeping desire during lectures (p=0.031) and mood swings (p=0.001).

Conclusion: Menstrual disorders were significantly high among the nursing students and most of them were suffering from premenstrual syndrome and dysmenorrhea. It had significant impact on academic performance of nursing students.

Retrospective Analysis of Spinal Anesthesia for Daycare Surgery during the COVID-19 Pandemic

Prajjwal Raj Bhattarai — 2022-12-31

Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in our center. During COVID-19 pandemic, we planned subarachnoid blocks for daycare surgeries, to minimize aerosol generation and to reduce virus transmission risk to health care professions.

Objectives: This study intended to compare time of discharge after subarachnoid block with general anesthesia in day care surgeries. We compare time to achieve post-anesthetic discharge score (PADS) equal to or more than nine; need for overnight hospitalization; and complications.

Methodology: A retrospective analysis of cases posted for elective daycare surgery in our institute during COVID-19 pandemic from April 2020 to July 2020 were identified. We compared time to discharge home in patients who received general anesthesia and spinal anesthesia. Normality of distribution was determined using Two sample Kolmogorov-Smirnov Tes. Student t test was used for normally distributed data, Mann-Whitney U test was used for non-normal distributed data. Categorical variables were analyzed using a chi-squared or Fisher’s exact test.

Results: A total of 2214 patients were included in this study.181 patients remained for analysis; 70 in the general anesthesia group and 91 in the spinal anesthesia group. Mean time (+SD) to achieve PADS score in group GA is 263.47(+75.06) whereas in group SAB was 339.55(+156.903). Mean time (+SD) taken to discharge home in group GA was 296.08(+74.76) whereas in group SAB was 365.66(+158.68) minutes respectively. Post hoc power of the study was 95.8.

Conclusion: With low dose bupivacaine, spinal anesthesia is a safe alternative for ambulatory day care surgeries.

A Descriptive Cross-Sectional Study on Clinical Profile and Outcome of Delirium in Trauma Patients in the Semi-Closed Intensive Care Unit of a Medical College

Alok Kumar Singh — 2022-12-31

Introduction: Delirium in trauma patients is common and underdiagnosed.

Objectives: This study aimed to identify the risk factors and outcome of delirium in trauma patients in a mixed semi-closed intensive care unit.

Methodology: This descriptive cross-sectional study was done on 77 patients of age 18 years or more admitted for more than 24 hours with the history of road traffic accidents, falls, drowning, physical assaults, and self- inflicted violence in a level three intensive care unit of the National Medical College for six months. The whole sampling method was used in our study and all cases during a given time were included in the study. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose delirium and level of arousal respectively. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-16. The Chi-square test and Fisher’s exact probability test were used to detect the difference between groups in the univariate analysis, as appropriate. The variables were analyzed using binary logistic regression. Any variables which had P<0.2 after the univariable risk regression and all other potential variables associated with the delirium were included for the multivariable risk regression. The level of significance was P<0.05.

Result: Of the 77 ICU admissions 17(22.1%) developed delirium. Hyperactive delirium was the most common motor subtype 9(52.9%). The mean duration of delirium was 3.69±4.06 days. Age, hypertension, blood transfusion, and orthopedic trauma were identified as risk factors for delirium. Delirious patients had a longer length of stay in the ICU (7.0 ±4.6 vs 4.5±4.1 days) with no impact on the duration of mechanical ventilation, mortality, reintubation, and unplanned extubation.

Conclusion: Age, hypertension, blood transfusion and orthopaedic trauma were identified as the risk factor for delirium in trauma patients that should be identified early to prevent complications such as longer length of stay in the ICU, longer duration of mechanical ventilation, mortality, reintubation and unplanned extubation.

Effect of Oral Clonidine Premedication on Hemodynamic Stress Response to Laryngoscopy and Tracheal Intubation

Jagat Narayan Prasad — 2022-12-31

Introduction: Different techniques have been tried to blunt undesirable hemodynamic effects like tachycardia, hypertension and dysarrhythmias during and after laryngoscopy and tracheal intubation.

Objective: To find out the effect of oral clonidine premedication on hemodynamic stress response to laryngoscopy and tracheal intubation.

Methodology: It was a prospective, randomized, double-blind comparative study conducted in patients undergoing laparoscopic cholecystectomy. Either oral clonidine 300 mcg (n=30) or placebo (n=30) was given one hour before the surgery. Depth of anesthesia was monitored and maintained at 40-60 level using bispectral index (BIS) monitor. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP) and oxygen saturation (SpO₂) at baseline, one hour after premedication, on operation theatre (OT) table, just before and after one, two and five minutes after laryngoscopy and intubation were compared in Clonidine and placebo group using Paired t test and Chi-square test. SPSS was used for statistical analysis at P-value<0.05

Results: Hemodynamic variables like HR, SBP, DBP and MBP were significantly lower in the clonidine group compared to placebo just before and after the first five minutes of laryngoscopy and tracheal intubation (P<0.05). Propofol requirement for induction of anesthesia was less in the clonidine group (95±31.8 mg vs 75.3±28.5 mg, p=0.014) compared to the placebo group. Adverse effects like hypotension and bradycardia were comparable in the groups. Time taken for extubation, time to follow verbal commands and time to orientation after surgery were similar in the both groups (P>0.05).

Conclusion: Oral clonidine premedication was effective in blunting undesirable hemodynamic stress response to laryngoscopy and tracheal intubation compared to the placebo.

Knowledge and Participation of Male Partners in Antenatal Care attending Antenatal Clinics in Birat Medical College Teaching Hospital

Tarun Pradhan — 2022-12-31

Introduction: Male partner participation and being prepared of complications and delivery during pregnancy is extremely important for successful pregnancy outcome.

Objective: Objective of this study was to assess Knowledge and participation of male partners in antenatal care attending antenatal clinics at Birat Medical College Teaching Hospital.

Methodology: A cross-sectional prospective study was done in Department of Obstetrics and Gynecology, BMCTH. Male partners accompanying primigravid pregnant lady were included. 150 male partners were included for the study. Knowledge of male partners were assessed using pre-tested questionnaire and the knowledge was scored for poor, average and good. Frequency and percentage were calculated for sociodemographic variables and male partner knowledge questionnaire.

Result: Majority of male partners accompanying wife were educated (96%) and skilled (81.3%). 89.3% were between 20-35 years. Both couples involved in decision making were 48.7% and 85.3% had planned pregnancy. 89.3% had good knowledge about importance of antenatal care, pregnancy complications and delivery preparedness. Knowledge of pregnancy related complication among male partners were significantly related to level of education, age of partner, employed and skilled partner and couple with planned pregnancy. Knowledge of delivery preparedness was significantly related to male partner education, occupation and if couple are making decision in family. Knowledge score of male partners showed significant relation with level of education, involvement in skilled occupations, involvement of couple in decision making.

Conclusion: Knowledge of male partners involved in antenatal care with pregnant lady showed good knowledge of antenatal care events, pregnancy related complication and also showed positive importance of hospital delivery.

Pattern of Hematological Diseases treated at Birat Medical College and Teaching Hospital

Sulav Sapkota — 2022-12-31

Introduction: Hematological diseases are increasing day to day in the eastern region of Nepal. There are very few centers providing treatment to hematological diseases patients in the eastern region of Nepal.

Objectives: The aim of this study is to stratify the types of hematological diseases treated at Birat Medical College and Teaching Hospital along with their demographic and clinic-pathological features.

Methodology: This descriptive cross-sectional study was conducted from 21 December 2020 to 20 July 2021 in the Department of Hemato-Oncology. All the clinically as well as laboratorically proven hematological disease patients receiving treatment during the study period were taken as study population. Hematological diseases are blood related diseases like anemia, blood cancers (like leukemia , lymphoma , multiple myeloma) ,hemolytic diseases , coagulation disease ,thrombocytopenia, etc. Data were entered and analyzed in Microsoft Excel version 2010 and IBM SPSS Statistics version 22 respectively.

Result: There were a total of 48 cases who received treatment during the study duration. The mean age of the cases was 50 (range 2-92) years with female gender almost equal to male gender. About 29% cases were involved in tobacco/ smoking . Majority of the cases involved were leukemia (33%), lymphoma (21%) ,hemolytic disease(11%) and Immune thrombocytopenic purpura(11%) cancer.We have good clinical remission (61%) of the cases, majority of which were non malignant cases. Total 77% of the cases were alive, 4% were referred while 19 % of the cases expired during the study period, majority of which were acute leukemias.

Conclusion:There is a rise of hematological cancer in eastern Nepal and hence there is a need for a comprehensive hematological center in the eastern region of Nepal.

Effectiveness of Use of Single Dose Preoperative Antibiotic versus both Pre and Post Operative Antibiotics in Patients Undergoing Laparoscopic Uncomplicated Appendectomy in Birat Medical College Teaching Hospital (BMCTH)

Bhupendra Charan Shrestha — 2022-12-31

Introduction: Acute appendicitis is one of the most common surgical emergency. Rationalized use of antibiotics prevents the risk of post operative complications. There is no conclusive recommendation on the duration of antibiotic usage and role of postoperative use of antibiotics in preventing complications in uncomplicated cases remains controversial till date.

Objectives: To compare the effectiveness of single dose preoperative antibiotic with preoperative and postoperative antibiotics for patients undergoing laparoscopic uncomplicated appendectomy.

Methodology: A total number of 113 patients who fulfilled the selection criteria underwent laparoscopic appendectomy for uncomplicated appendicitis and were randomly divided into two groups. Group A patients received only pre operative antibiotics whereas Group B patients received both preoperative and postoperative antibiotics. Patients of both the groups were followed up postoperatively till discharge from the hospital

Results: In this study, patients who received only pre-operative antibiotic were 57 (50.4%) and patients who received both preoperative and postoperative antibiotics were 56(49.6%). SSI was detected in total of 2 patients (1.8%) one from each group and postoperative lump noted in right iliac fossa (RIF) in 2 patients (1.8%) one in each group intraoperatively in which further antibiotic was continued postoperatively. Hematoma, seroma and peritonitis were absent in both the groups. The difference between the two groups for incidence of SSI and postoperative RIF lump was statistically insignificant with P value of 0.748.

Conclusion: Single dose preoperative antibiotic is sufficient in preventing postoperative complications in patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. This can be recommended for implementation as standard operating protocol in such cases.

Comparative Study between Laparoscopic Common Bile Duct Exploration plus Cholecystectomy versus Endoscopic Retrograde Cholangiopancreatography plus Cholecystectomy for Cholecysto-Choledocholithiasis

Rohit Prasad Yadav — 2022-12-31

Introduction: The management of concomitant gallbladder and common bile duct stones have been debated between both endoscopic and laparoscopic techniques.

Objective: The objective of this study is to compare the efficacy, safety, cost and surgical outcomes of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography plus cholecystectomy.

Methodology: This is a comparative interventional study carried out among 62 patients with concomitant gallstones and common bile duct stones. The study population was divided into two groups by simple randomized sampling technique (lottery technique). Group A underwent laparoscopic common bile duct exploration followed by laparoscopic cholecystectomy in one stage (single-staged management). Group B underwent endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy in second hospital visit (two-staged management).

Results: Complete clearance of the stone with a single attempt was achieved in Group A compared to Group B as 8 patients had gone for a second attempt in group B. Post operative pancreatitis was higher i.e. 24(77.41%) in Group B with statically significance (p value <0.005). Other complications like bleeding i.e. 29(93.54% in A and 26(83.87%) in B group, perforation was also noted during the study period that includes 29(93.54%) in B group. The mean operative time was longer in Group A i.e. 130.2 ± 41.5 minutes while in Group B was 78.5± 10.2 minutes which was statistically significant (p <0.001).The cost of procedure was higher for patients undergoing two-staged management.

Conclusion: The complete clearance of the stone with a single attempt was achieved in Group A compared to Group B where 8 patients had a second attempt. Also incidence of pancreatitis was higher in Group B and statically significant. Other complications like bleeding perforation was also noted during the study period in B group. The mean operative time was longer in Group A which was statistically significant. However, for those patients with concomitant gallbladder and common bile duct stones, single-staged management consisting of laparoscopic common bile duct exploration and laparoscopic cholecystectomy could be the preferred method of treatment where the expertise and facilities are available.

Assessment of Thyroid Function in Neonates Born to Hypothyroid Mothers

Nabal Kishor Ray — 2022-12-31

Introduction: Congenital hypothyroidism is a preventable cause of intellectual disability in childhood. It is one of the commonest endocrine conditions encountered in the neonatal period. Maternal Thyroid Status has long been recognized as having an impact on the developing fetus, and more recently a family history of thyroid dysfunction has been implicated as a risk factor in congenital hypothyroidism (CH). Therefore, this study focused on thyroid screening in neonates born to hypothyroid mothers.

Objective: The aim of this study was to assess the thyroid function in neonates born to hypothyroid mothers.

Methodology: This was a hospital based cross-sectional observational prospective study conducted at Birat Medical College and Teaching Hospital from March 2021 to May 2022. A total of 109 neonates born to hypothyroid mothers were included in the study. Thyroid functions of these babies were assessed at 72 hours of life. The data was entered into Microsoft offices excel and analyzed using statistical package for social sciences (SPSS 20).

Results: Out of 109 neonates born to hypothyroid mothers, <1% was found to have a high TSH Level above the upper limit of reference cut off value (20miu/L) and was considered to be abnormal (congenital hypothyroidism).

Conclusion: All the newborns except one had normal TSH levels which were probably due to early diagnosis and timely initiation of treatment to the mothers with hypothyroidism.

Fabrication of Feeding Plate in Neonates with Cleft Lip and Palate: Case Series

Parayash Dallakoti — 2022-12-31

Cleft lip and palate (CLP) is a common craniofacial anomaly which can be syndromic or non-syndromic. In children with CLP, feeding is the biggest concern due to lack of oral seal owing to the presence of clefts in the oral cavity. To achieve a near normal feeding, feeding plates are delivered to restore the separation thus helping to create negative intraoral pressure during suckling. Impression making for the fabrication of feeding plate is incredibly challenging procedure but selection of appropriate impression material, patient positioning during impression making and preparation for management of emergency mishaps can make the procedure easier and safer. Present case series highlights the fabrication and delivery of feeding plates made up of two different materials (Ethylene vinyl acetate and self-cure acrylic resin) in three neonates who were four, fourteen and five days old.

Persistent Pyrexia in Tetanus: A Case Report from Nepal

Bikash Khadka — 2022-12-31

Tetanus, an infection caused by the gram-positive, obligate anaerobic bacillus Clostridium tetani, is still prevalent in developing countries. Fever is an unusual symptom in tetanus. The disease must be managed by preventing tetanospasmin absorption, treating symptoms, stabilizing autonomic instability, using antibiotics, and controlling the airway with assisted ventilation if necessary. We present a case report of a tetanus patient who had persistent pyrexia despite ruling out all the obvious causes of fever ,that coincide with the persistence of muscle spasms and/or use of prolonged duration of benzodiazepines.

LASERS in Urology

Dipak K. Thakur — 2022-12-31

No abstract available.