Birat Journal of Health Sciences https://www.nepjol.info/index.php/bjhs <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="http://bjhsnepal.org/" target="_blank" rel="noopener">http://bjhsnepal.org/</a></p> Birat Medical College and Teaching Hospital en-US Birat Journal of Health Sciences 2542-2758 <p>This license allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator.</p> Functional outcome of column specific fixation in the management of complex tibial plateau fractures https://www.nepjol.info/index.php/bjhs/article/view/49293 <p><strong>Introduction: </strong>Complex tibial plateau fractures usually have complicated intra-articular fracture pattern, often associated with severe soft tissue injury and high risk of wound complications. Single or dual column plating fixation principle based upon conventional x-ray for such fractures may not address multiplanar comminution that&nbsp; often has posterior shearing or&nbsp; coronal fractures. Computed tomography based evaluation of such fractures&nbsp; and column specific&nbsp; approach allow direct fracture visualization and anatomic reduction&nbsp; that results in satisfactory outcome.</p> <p><strong>Objectives: </strong>To assess the clinical and functional outcome and complications of complex tibial plateau fractures fixed with column specific fixation principle.</p> <p><strong>Methodology:</strong> This prospective study was carried out from September 2019 to August 2021 in Orthopaedic department of Nobel Medical College, Biratnagar. Consecutive sampling was used among patient with complex tibial plateau fractures meeting the inclusion criteria. Among 30 patients, with&nbsp; closed and Gustilo grade I or II Schatzker type V-VI fractures or AO type-C injuries to the proximal tibia were operated on column specific approach and followed up for clinico-radiological evaluation.</p> <p><strong>Results:</strong> In this study, most of the patients belonged to 31-40 years of age group with mean age of 40.47 years. Majority of patients were male( 76.7%). Fracture was highly associated with road traffic accident which accounted for 83%. Fourteen patients underwent anteromedial and anterolateral plating(46.67%), 10 patients underwent anterolateral and posteromedial plating(33.33%) and remaining 6 patients underwent triple column plating(20%). The Rasmussen’s functional score at final follow up was&nbsp; 27.17±2.793(range 21-30). 86.7% patients had acceptable clinical outcome. The mean Rasmussen’s radiological score at final follow up was 8.97±1.217(range 6-10). Thus 93.4% patients had acceptable radiological outcome.</p> <p><strong>Conclusion: </strong>Column specific approach addresses all the fracture fragments of complex tibial plateau fractures to achieve acceptable clinical and radiological outcome.</p> Bishwamber Thapa Prakash Sitoula Ranjib Jha Santosh Thapa Copyright (c) 2022 Bishwamber Thapa, Prakash Sitoula, Ranjib Jha, Santosh Thapa https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1753 1757 10.3126/bjhs.v7i2.49293 Role of Histopathology in diagnosis of Soft Tissue Tumors at Tertiary Care Center https://www.nepjol.info/index.php/bjhs/article/view/49294 <p><strong>Introduction: </strong>Soft tissue tumors (STTs) are a diverse group of neoplasms. It varies from the most common benign tumors to some self-limited lesions and rare malignant soft tissue tumors. Because of the overlap in their clinical and radiological characteristics, histopathology is crucial in determining their diagnosis.</p> <p><strong>Objectives: </strong>To study the relative frequencies of types of soft tissue tumors (benign, intermediate and malignant) as well as their histological pattern in relation to age, gender and site of distribution.</p> <p><strong>Methodology: </strong>This was a retrospective study conducted over a period of three years from January 2018 to December 2020 in the Department of Pathology, Dhulikhel Hospital, Kavre Nepal. This study included STTs of all the anatomical sites excluding STTs of the female reproductive system. The tumors were classified as benign, intermediate, or malignant using the WHO 2013 classification of soft tissue and bone tumors. The sarcomas were further graded into grades 1, 2, and 3 using&nbsp;the FNCLCC (French Federation Nationale des Centres de Lutte Contre le Cancer) grading system. Immunohistochemistry (IHC) and special staining procedures were also performed as and when required.&nbsp;</p> <p><strong>Result: </strong>A total of 198 STTs were studied, of which benign cases were 191 (96.45%), intermediate 03 (1.52%) and malignant 04 (2.03%) in number. The most common type of STTs was vascular tumors 77(38.89%) followed by adipocytic tumors 52(26.26%) and nerve sheath tumors 13(6.56%). STTs were most common in the third decade of life, with the head and neck region &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;being the commonest site.&nbsp; All four malignant tumors were categorized using the FNCLCC grading system. There were three cases of Grade 2 sarcoma and one case of Grade 3 sarcoma.</p> <p><strong>Conclusion: </strong>The most common benign tumors were vascular tumors followed by adipocytic tumors and nerve sheath tumors. STTs were most common in the third decade of life. Benign tumors were more common than malignant tumors.&nbsp; In comparison to malignant tumors, benign tumors were found at a younger age group. STTs were found mainly in the head and neck region followed by upper and lower limbs. Despite the fact that molecular diagnostics is gaining popularity in the field of soft tissue tumors, histopathology still remains the gold standard.</p> Nikita Gautam Ramesh Makaju Rachana Dhakal Dipika Basnet Binita Lama Copyright (c) 2022 Nikita Gautam, Ramesh Makaju, Rachana Dhakal, Dipika Basnet, Binita Lama https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1758 1764 10.3126/bjhs.v7i2.49294 Gestational Trophoblastic Neoplasia: A Clinico-Epidemiological Profile In A Tertiary Care Hospital https://www.nepjol.info/index.php/bjhs/article/view/49295 <p><strong>Introduction:</strong> Gestational trophoblastic neoplasia (GTN) is a group of interrelated lesions that results from abnormal proliferation of placental trophoblastic cells. Early diagnosis and treatment of GTN results in successful outcomes with fertility preservation.This study was intended to stratify GTN cases using WHO scoring system, to diagnose and manage cases as per protocol and to identify complications of treatment of GTN.</p> <p><strong>Methodology: </strong>This was a single center prospective observational study conducted at Medical college Kolkata from June 2017 to December 2018. All the diagnosed cases of GTN fulfilling the inclusion criteria were incorporated in the study, data were collected from history, clinical examination and investigations. All the data were tabulated and analyzed by standard statistical methods</p> <p><strong>Results:</strong>&nbsp; In this study,&nbsp; primiparous are more prone to have GTN and&nbsp; molar pregnancy was the commonest antecedent event (71.4% of cases). 74.3% (26 out of 35) patients developed disease within four months of previous pregnancy. Anemia and vaginal bleeding were the presenting symptoms in &gt;48.0% cases whereas hemoperitoneum,seizure, hemoptysis and respiratory distress were the rare presenting symptoms.In this study, the cases were diagnosed by histopathology or serial estimation of serum β-hcg. In our study, 91.4% patients&nbsp; were successfully treated with methotrexate and only three cases received EMACO.</p> <p><strong>Conclusion:</strong> To conclude this study established that cases of GTN can be successfully treated by early diagnosis and timely management.</p> Indrani Das Payel Mandal Sandip Samanta Pallab Kumar Mistri Amit Kyal Partha Mukhopadhyay Copyright (c) 2022 Indrani Das, Payel Mandal, Sandip Samanta, Pallab Kumar Mistri, Amit Kyal, Partha Mukhopadhyay https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1765 1769 10.3126/bjhs.v7i2.49295 Incidence of Color Blindness among Undergraduates Students of Medical College in Pokhara https://www.nepjol.info/index.php/bjhs/article/view/49296 <p><strong>Introduction:</strong> There are many genetic disorders that are X-linked, one being the color blindness. Some individuals affected with the disorders may remain unaware till detected for a long time. There are very few reports about the incidence of the color blindness among the medical undergraduate students. </p> <p><strong>Objectives:</strong> Ojective of our study was to assess the color blindness incidence, among the medical undergraduates at the Gandaki Medical College, Pokhara. </p> <p><strong>Methodology:</strong> We piloted an observational cross-sectional study among the first and second year medical students (MBBS, BDS, Nursing, and paramedics) at Gandaki medical college. We finalized 300 students of both the genders based on the inclusion criteria. We performed in the natural day light, the color vision test using the Ishihara plates. We assessed incidence, the type of the color blindness and the gender distribution among the subjects. We compared the data thus obtained applying the “chi square statistical test” deliberating p&lt;0.05 as significant.</p> <p><strong>Results:</strong> We observed that all the colorblind subjects in the study were male who constituted 2% of the all the subjects. There was significant difference statistically among the types of the color blindness with majority having Deuteranomaly.</p> <p><strong>Conclusions:</strong> We can conclude that incidence of the color blindness was exclusive among men in our study. Total color blindness was seen in majority of the male subjects. Screening the students will enable the unaware students of their disability and hence they can be guided to proper counseling. </p> Ripti Shrestha Bijendra Prasad Yadav Neebha Amatya Rajab Rana Rajesh Prajapati Copyright (c) 2022 Ripti Shrestha, Bijendra Prasad Yadav, Neebha Amatya, Rajab Rana, Rajesh Prajapati https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1770 1774 10.3126/bjhs.v7i2.49296 Nepali Translation and Validation of Dental Satisfaction Questionnaire https://www.nepjol.info/index.php/bjhs/article/view/49297 <p><strong>In</strong><strong>troduction:</strong> Patient satisfaction is regarded as an important outcome of health care that contributes to better patient compliance and consequently offers improved clinical outcomes Dental school clinics must regulate both the clinical and academic classes in balance without hampering the needs of both the patient and students.</p> <p><strong>Objectives:</strong> To develop a reliable and valid Nepali version of Dental Satisfaction Questionnaire (DSQ-N).</p> <p><strong>Methodology: </strong>The English version of the dental satisfaction questionnaire (DSQ) was translated into Nepali following a standard translation process. Content validity followed by pre-testing were evaluated to obtain the final version of DSQ-N. Two hundred patients attending the Department of Conservative Dentistry and Endodontics completed the DSQ-N in the waiting room, at their convenience. Internal consistency of the questionnaire was determined by Cronbach's alpha and Principal component analysis was used to determine the construct of the scale.</p> <p><strong>Result: </strong>Content Validity Index of the scale was 0.9 (S-CVI/ Avg) and alpha (Cronbach's) coefficient for the overall construct of DSQ was ≈0.83. Principal Component Analysis confirmed the internal structure of the scale and four components emerged from it.</p> <p><strong>Conclusion: </strong>&nbsp;The translated nepali version of DSQ is a reliable and valid tool to determine patients’ satisfaction of dental care services based on the excellent content validation result together with robust internal reliability.</p> Arbind Rai Sneha Shrestha Ashok Ayer Navin Agrawal Mannu Vikram Copyright (c) 2022 Arbind Rai, Sneha Shrestha, Ashok Ayer, Navin Agrawal, Mannu Vikram https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1775 1779 10.3126/bjhs.v7i2.49297 Clinico-pathological Study of Solid Cancer patients receiving chemotherapy at Birat Medical College Teaching Hospital https://www.nepjol.info/index.php/bjhs/article/view/49298 <p><strong>Introduction</strong>: Solid cancers are increasing in eastern region of Nepal. There are very few centers providing chemotherapy treatment to solid cancer patients in eastern region of Nepal.</p> <p><strong>Objectives</strong>: The aim of this study is to stratify the types of solid cancers and study their socio-demographic and clinicopathological features of solid cancer.</p> <p><strong>Methodology</strong>: This descriptive cross sectional study was conducted from 1st September 2020 to 1st july 2021 at the department of Oncology . All the histologically proven patients of solid cancers, derived from solid organs like lung, stomach, liver, breast etc, receiving chemotherapy during the study period were taken as study population. All the relevant data were entered in the excel sheet and analyzed by the help of statistical software.</p> <p><strong>Result</strong>: There were total seventy three cases who got admitted for chemotherapy during the study duration at the department of Oncology. The patients were between 30-85 years, with the mean age of 59 years and the proportion of females were almost double (64%) than male. 78% cancers were advanced staged in contrast to 22% early stage cancers. Cases were majorly with clinical remission (30%) out of which most common were breast and colorectal cancers. Total 58% of the cases were alive while 42% of the cases expired during the study period.</p> <p><strong>Conclusion</strong>: There is a need of comprehensive cancer center in eastern region of Nepal due to increase in the burden of solid cancers.</p> Sulav Sapkota Mona Priyadarshini Copyright (c) 2022 Sulav Sapkota, Mona Priyadarshini https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1780 1783 10.3126/bjhs.v7i2.49298 Nutrition Status of Cancer Patients Attending Oncology Unit at Birat Medical College https://www.nepjol.info/index.php/bjhs/article/view/49299 <p><strong>Introduction:</strong> Malnutrition is a major problem in cancer patients which results in high morbidity and mortality. There are lack of comprehensive centers providing nutritional support to cancer patients in eastern region of Nepal.</p> <p><strong>Objective:</strong> The objective of this study was to analyze the malnutrition status of cancer patients at Birat Medical College. It aimed to calculate the prevalence of malnutrition in cancer patients.</p> <p><strong>Methodology:</strong> This descriptive cross sectional observational study of six months duration was conductedfrom 15<sup>th </sup>January 2021 to 15<sup>th</sup> July 2021 in the department of Oncology at Birat Medical College Teaching Hospital.All the histologically proven cancer patients during the study period were taken as study population whose body mass index were calculated. The relevant data were maintained inexcel sheet and analysis was done with the help of statistical software SPSS version22.</p> <p><strong>Results:</strong> A total of 70 cases attended oncology unit during the study duration at Birat Medical College. The mean age of the cases were60 years (range 21-85) with the proportion of female patients almost equal(53%) to that of males. There was total 28 (40%) malnutrition cases out of which 22% were overweight,17% were underweight and only 1% obese. During the study period total 50% of the malnutrition cases were alive and 50% cases expired due to disease progression.</p> <p><strong>Conclusion:</strong> Malnutrition is a major concern worldwide and even in cancer patients of Nepal. There is a need of comprehensive cancer center providing nutritional support to cancer patients in eastern region of Nepal.</p> Mona Priyadarshini Gyanendra Man Singh Karki Sulav Sapkota Copyright (c) 2022 Mona Priyadarshini, Gyanendra Man Singh Karki, Sulav Sapkota https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1784 1788 10.3126/bjhs.v7i2.49299 Study of Gastro-Oesophageal Reflux Disease among Patients with Type 2 Diabetes Mellitus presenting to Medicine Department at a Tertiary Care Hospital: A Descriptive Cross-sectional Study https://www.nepjol.info/index.php/bjhs/article/view/49300 <p><strong>Introduction:</strong> Gastro-oesophageal reflux disease is a chronic condition in which stomach contents regurgitates up into oesophagus causing symptoms like acidic taste in mouth, heart burn, bad breath and chronic cough. There is high prevalence of GERD in patients with Type 2 diabetes mellitus in the western countries, but such related data in our country are just few.</p> <p><strong>Objectives: </strong>To find out the prevalence of gastroesophageal reflux among patients with Type 2 Diabetes Mellitus attending Nobel Medical College Teaching Hospital.</p> <p><strong>Methodology:</strong> This was a descriptive cross-sectional study carried out in Department of Medicine of a tertiary care hospital from July 2020 to June 2021. Ethical approval was taken from Institutional Review Committee of Nobel Medical College Teaching Hospital (Reference number: 464/2020). Convenience sampling was done and data was collected from 191 patients presenting to the department. Collected data was entered, analysed in Statistical Package for the Social Sciences version 21 and documented for study. Point estimate at 95% Confidence Interval and descriptive statistics were interpreted as frequency, percentage, or as mean and standard deviations.</p> <p><strong>Results</strong>: Among 191 patients with type 2 diabetes, gastroesophageal reflux was seen in 78 (40.84%) (33.87-47.81 at 95% Confidence Interval) with more prevalent in male 42 (53.84%) than female 36 (46.15%). Mean duration of type 2 diabetes among reflux cases was 10.20± 5.40 years.</p> <p><strong>Conclusions:</strong> Gastroesophageal reflux was common associated condition among Diabetic patients.</p> Arun Kumar Mahato Madhu Shah Nischal Shrestha Copyright (c) 2022 Arun Kumar Mahato, Madhu Shah, Nischal Shrestha https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1789 1793 10.3126/bjhs.v7i2.49300 Awareness of cross-infection and its control measures among patients attending a tertiary dental hospital in Nepal https://www.nepjol.info/index.php/bjhs/article/view/49303 <p><strong>Introduction: </strong>Dental procedures frequently lead to exposure to blood and saliva which can carry a variety of pathogens. Aerosols produced during dental treatment procedures can further facilitate the transmission of these infectious agents. It is equally important for the patients to be aware of cross-infection and measures taken to prevent it in a dental setting.</p> <p><strong>Objectives: </strong>The main objective of this study was to assess the awareness of cross-infection and its control measures among patients attending College of Dental Surgery, B.P. Koirala Institute of Health Sciences (BPKIHS).</p> <p><strong>Methodology: </strong>A cross-sectional study was carried out among 362 patients who attended College of Dental Surgery, BPKIHS. Data was collected by administering a questionnaire that consisted of 4 questions intended to collect sociodemographic information and 10 close-ended questions designed to assess awareness of cross-infection and its control measures. The data was entered and analyzed using SPSS® software for Windows®.</p> <p><strong>Results: </strong>The majority of the participants were aware that there was a chance for an infection to be transmitted from a dentist to a patient (82%), from a patient to a dentist (80.4%), and in between patients attending the same dental clinic (70%). Most of the participants considered wearing gloves (94.4%) and facemask (86%) by the dentist to be important. Only 40.3% of participants were aware of better methods of sterilization other than boiling in water. Awareness was higher among participants with higher education (p&lt;0.05).</p> <p><strong>Conclusion: </strong>The majority of the participants were aware that there was a chance for an infection to be transmitted from a dentist to a patient. However, the dental healthcare professionals should educate people about the possible risks of cross-infection and the importance of infection-control practices in dental clinics. Modern mass media and social media can be used to spread awareness to a large segment of the population.</p> Sushant Pandey Utsav Shrestha Regina Dahait Copyright (c) 2022 Sushant Pandey, Utsav Shrestha, Regina Dahait https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1794 1798 10.3126/bjhs.v7i2.49303 Knowledge on Post Exposure Prophylaxis of HIV among Nurses of a Private Hospital https://www.nepjol.info/index.php/bjhs/article/view/49304 <p><strong>Introduction</strong>: There are many effective prevention interventions available for those experiencing occupational exposure, and post exposure prophylaxis (PEP) is one of them. Different studies worldwide have shown low utilization of PEP for HIV due to lack of adequate knowledge.</p> <p><strong>Objective</strong>: The purpose of this study was to assess the knowledge on PEP of HIV among nurses.</p> <p><strong>Methodology</strong>: Descriptive cross-sectional research design was used and all the 130 nurses working in a private hospital of Biratnagar were the sample. Self-administered semi-structured questionnaire was used. Descriptive statistics as percentage, mean, median and standard deviation were used to analyse the data.</p> <p><strong>Results</strong>: Almost all of the nurses knew the meaning of PEP and the majority were aware about components, indications and best time for initiating PEP after exposure. Less than half had knowledge about appropriate treatment regimen, antiretroviral drugs used for PEP, PEP drugs contraindicated during pregnancy, effectiveness of PEP and duration of protection by PEP. Findings also revealed that only one-third of the nurses (35.8%) had adequate knowledge on PEP of HIV.</p> <p><strong>Conclusion</strong>: In least developed and developing countries like Nepal, healthcare workers including nurses have to work in resource-limited settings, putting themselves at higher risk of contracting different blood borne infections, including HIV, a disease without cure so far. Thus the findings reflect the need for the in-service awareness program and the integration of content in the pre-service curriculum on PEP of HIV for the nurses who are at risk for occupational exposure.</p> Deepika Khadgi Pooja Shah Anju Mahato Karishma Khadgi Copyright (c) 2022 Deepika Khadgi, Pooja Shah, Anju Mahato, Karishma Khadgi https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1799 1803 10.3126/bjhs.v7i2.49304 Prevalence of surgical site infection among bile spillage and non-spillage patients undergoing laparoscopic cholecystectomy: A cross-sectional study https://www.nepjol.info/index.php/bjhs/article/view/49305 <p><strong>Introduction: </strong>Laparoscopic cholecystectomy, a common procedure is not without complications, and bile spillage can cause surgical site infection (SSI). There is no local evidence in our hospital setting.</p> <p><strong>Objective: </strong>The objective of this study was to find the prevalence of surgical site infection among bile spillage and non-spillage patients following laparoscopic cholecystectomy at BMCTH</p> <p><strong>Methodology: </strong>A hospital-based cross-sectional study was conducted from 25 February 2021 to 25 August 2021 at the surgery department of BMCTH. We enrolled 120 patients through the total enumeration technique who underwent laparoscopic cholecystectomy. We enrolled all the eligible study participants who were more than 18 years excluding patients having age &gt;75 years, acute calculous cholecystitis, evidence of cholangitis and/or obstructive jaundice, previous biliary tract surgery, or previous Endoscopic retrograde cholangiopancreatography, evidence of uncontrolled diabetes mellitus and patients taking immunosuppressive drugs and immunosuppressed conditions like HIV/AIDS. The surgical site infection was assessed on the 7th postoperative day.</p> <p><strong>Results: </strong>Among 120 patients undergoing laparoscopic cholecystectomy, the majority were female 92(76.7%) and 40-50 years age group 65(54.2%). Bile spillage was found in 27(22.5%) and non-spillage in 93(77.5%).&nbsp; The prevalence of surgical site infection (SSI) was found to be 7.5% which was more in the bile spillage group 25.9% than the non-spillage group 2.2%. The odds of having SSI among the spillage group was 15.9 times more than the non-spillage group and was statistically significant (p &lt;0.05).&nbsp; The pus culture of SSI found the predominant organism as Staphylococcus aureus 6(66.7%) followed by Escherichia coli 3(33.3%). The common indications of laparoscopic cholecystectomy were symptomatic cholelithiasis 95(79.1%) followed by chronic calculus cholecystitis 15(12.5%), gall bladder polyp 8(6.7%) and gall stone pancreatitis 2(1.7%).</p> <p><strong>Conclusion: </strong>More than two and almost one out of ten had bile spillage and surgical site infection (SSI) respectively.&nbsp; A significantly higher number of SSI among the spillage group should be a concern of surgeons. We need to be extra careful with the spillage group for surgical site infection.</p> Sameer Bhattarai Dinesh Nalbo Sanjib Koirala Ram Kumar Singh Copyright (c) 2022 Sameer Bhattarai, Dinesh Nalbo, Sanjib Koirala, Ram Kumar Singh https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1804 1807 10.3126/bjhs.v7i2.49305 Outcomes of Arterio-venous Fistula Reconstruction in Chronic Kidney Disease Patients Presenting in Tertiary Care Hospital in Eastern Nepal https://www.nepjol.info/index.php/bjhs/article/view/49306 <p><strong>Introduction:</strong> Renal Replacement Therapy is the treatment modality for the chronic kidney disease (CKD) which ranges from hemodialysis, peritoneal dialysis to the renal transplantation, the latter being the best form of treatment. But, renal transplantation is available at limited centers only so hemodialysis is the most commonly used treatment modality of chronic kidney disease which requires a vascular access. But there are limited vascular surgeons in the region so most of the arterio-venous (AV) fistulas are reconstructed by Urologist/Surgeons exposed to vascular surgery during their residency/training period.</p> <p><strong>Objectives:</strong> To know the factors influencing the site selection, to assess the success rate and to document the complications of AV fistula reconstruction.</p> <p><strong>Methodology:</strong> This is a hospital based prospective observational study conducted in the Birat Medical College – Teaching Hospital, Morang, Nepal from June 2021 to May 2022. We included the CKD patients requiring vascular access for hemodialysis with Color Doppler available for vascular mapping. Patients with brachial sites previously used and without Color Doppler were excluded from the study. AVF was reconstructed under local anesthesia and outcomes were recorded.</p> <p><strong>Results:</strong> Thirty one patients of CKD underwent AVF reconstruction over the study period. Male and female ratio was 1.33 (57% and 43%). The mean age was 42.14 ± 11.34 years (Range 26-65 years). The mean diameter of radial artery (RA) and cephalic vein (CV) at wrist were 1.92 ± 0.56mm and 1.91 ± 0.20 mm respectively. Similarly, the mean diameter of brachial artery (BA) and CV at elbow were 3.66 ± 0.87mm and 3.57 ± 0.55 mm respectively. The fistula reconstructed were Lt RC (radio-cephalic) – 50% (14), Lt BC (brachio-cephalic) -35.71% (10) and Lt BB ( brachio-basalic) - 14.29% (4) respectively. Complications occurred in 4 cases (14.28%).</p> <p><strong>Conclusion:</strong> Selection of type of AVF creation is influenced by the vessel diameter as well as previous fistula surgery status and AVF access for hemodialysis has adequate patency with acceptable complications.</p> Dipak Kumar Thakur Ajay Kumar Yadav Chandra Shekhar Agrawal Copyright (c) 2022 Dipak Kumar Thakur, Ajay Kumar Yadav, Chandra Shekhar Agrawal https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1808 1811 10.3126/bjhs.v7i2.49306 A Comparative Study of Alkalined and Plain Local Anesthetic on Onset, Duration and Quality of Bracheal Plexus Block by Supraclavicular Approach. https://www.nepjol.info/index.php/bjhs/article/view/49307 <p><strong>Introduction: </strong>Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in term of such damage. The relief from pain is the essence of anesthesia. Peripheral nerve blocks provide longer and more localized pain relief than neuraxial techniques while also avoiding the side effects of systemic medication. This study was aimed to find the effectiveness of Study solution (addition of Sodium bicarbonate to 0.375% Bupivacaine) on onset time, duration and quality of Brachial Plexus Block.</p> <p><strong>Material and methods: </strong>This study was conducted among 60 different patients undergoing surgical procedure of the upper limb. They were categorized into two different groups. The first group (Group 1), 30 patients received Brachial Plexus block with 30 ml of study solution (0.375% Bupivacaine with 2 ml of Sodium bicarbonate7.4%). The second group (Group 2) received 30 ml of 0.375 % plain bupivacaine only and the differences in onset, duration and quality of blockade were studied.</p> <p><strong>Result: </strong>The similarity of age between the two groups can be seen. In Group 1 the mean onset time of sensory blockade was 9.43 minutes and motor blockade was 10.43 minutes when compared to Group 2 having sensory onset of minutes 23.93 and motor onset of 26.33 minutes. Similarly, In Group I the mean duration of sensory blockade was 477.67 minutes and motor blockade were 467.67 minutes when compared to Group 2 having sensory duration of 215.67 and motor duration of 205.67 minutes. The quality of sensory blockade was also better in group1 (P-Value:0.006).</p> <p><strong>Conclusion: </strong>Addition of Sodium bicarbonate to bupivacaine had significant clinical advantage over plain bupivacaine on onset time, duration and quality of sensory and motor blockade in brachial plexus block.</p> Rajesh Kumar Yadav Ajay Singh Thapa Rakesh Sah Copyright (c) 2022 Rajesh Kumar Yadav, Ajay Singh Thapa, Rakesh Sah https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1812 1815 10.3126/bjhs.v7i2.49307 Evan’s Index in adult Nepalese population: A Computerized Tomographic Study https://www.nepjol.info/index.php/bjhs/article/view/49311 <p><strong>Introduction: </strong>Evan's Index is a linear measurement of the ventricular size which is used as an indirect marker of ventricular volume. It is used widely as a screening tool to rule out ventricular enlargement. As the ventricular enlargement indicates the neuropathological state of the brain, Evan's Index serves as the quick and reliable method to assess ventricular size.</p> <p><strong>Objectives:</strong> The study aims to generate a baseline value of Evan's Index among the Nepalese population and also investigates the effect of age and gender on EI.</p> <p><strong>Methodology:</strong> A quantitative study was conducted in the Department of Anatomy, Kathmandu University School of Medical Sciences and data was collected from the Department of Radiodiagnosis, Dhulikhel Hospital, Kathmandu University Hospital. The study was done on 385 head CT Scans of the individuals of mean age of 45.44years. The ratio of inter anterior horns distance of the lateral ventricles and maximal internal diameter of the skull at the same level was taken to calculate Evan’s Index.</p> <p><strong>Results:</strong> The mean value of Evan’s index in the present study was 0.250.03. The study did not report gender-wise variation in Evan's Index (p&gt;0.05). Evan’s index was minimum at the age group of 20-29 and maximum at the age group of 80-89. The value of Evan’s Index showed a significant increase with the age (p&lt;0.05).</p> <p><strong>Conclusions:</strong> The study provides the mean value of Evan’s Index among the Nepalese population. Even though Evan’s Index is not influenced by gender, the value increases with normal aging.</p> Pragya Shrestha Dil Islam Mansur Subindra Karki Sunima Maskey Bishal Sah Roshan Chaudhary Copyright (c) 2022 Pragya Shrestha, Dil Islam Mansur, Subindra Karki, Sunima Maskey, Bishal Sah, Roshan Chaudhary https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1816 1820 10.3126/bjhs.v7i2.49311 Outcome of unstable intertrochanteric fractures managed with Proximal Femoral Nail Anti-rotation-II: A study in elderly Nepalese population. https://www.nepjol.info/index.php/bjhs/article/view/49308 <p><strong>Introduction:</strong> The ideal implant for treating unstable intertrochanteric fracture has been controversial. Studies have shown good results with various intra-medullary nails. Likewise, Proximal Femoral Anti-rotation-II (PFNA-II) has been designed for the Asian population. But the knowledge about the outcomes of PFNA II in our particular region has been lacking.</p> <p><strong>Objectives : </strong>To evaluate the radiological and functional outcome of unstable intertrochanteric fractures in elderly patients managed with PFNA-II.</p> <p><strong>Methodology:</strong> This is a prospective clinical study conducted at Nobel Medical College between February 2019 and March 2021. Patients above 65 years of age with unilateral unstable intertrochanteric fracture were managed with PFNA-II. Radiological union and complications were recorded. Functional outcome was assessed on the basis of modified Harris Hip Score.</p> <p><strong>Results:</strong> Twenty-nine patients were included in the final evaluation and had at least one year follow-up. Two patients (6.8%) had superficial infection. The average Tip Apex Distance (TAD) was 22.28 mm (range, 18- 28 mm). Mean modified Harris Hip Score at one year was 82.59 with good outcome in 23(79.3%) patients.</p> <p><strong>Conclusion:</strong> This study showed that good clinical outcome can be obtained when radiological parameters are restored. Good intra-operative fracture reduction, and optimal positioning and length of helical blade are crucial. We believe that PFNA-II is an excellent implant to treat unstable intertrochanteric fractures in elderly patients.</p> Suman Dhoj Kunwar Prakash Sitoula Ranjib Kumar Jha Bishwamber Thapa Ashish Rajthala Copyright (c) 2022 Suman Dhoj Kunwar, Prakash Sitoula, Ranjib Kumar Jha, Bishwamber Thapa, Ashish Rajthala https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1821 1825 10.3126/bjhs.v7i2.49308 End of Life Care : Challenges in Nepal https://www.nepjol.info/index.php/bjhs/article/view/49292 <p>N/A</p> Sulav Sapkota Mona Priyadarshini Copyright (c) 2022 Sulav Sapkota, Mona Priyadarshini https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 10.3126/bjhs.v7i2.49292 Large Radicular cyst disfiguring the midline face; a case report https://www.nepjol.info/index.php/bjhs/article/view/49309 <p>A radicular cyst is an inflammatory odontogenic cyst of the jaw commonly found at the apices of the tooth of the anterior maxilla. It develops as a sequel of untreated dental caries with pulp necrosis and periapical infection. Different treatment includes surgical endodontic treatment, extraction of the involving tooth, marsupialization, and enucleation with primary closure followed by rehabilitation. We presented a case of a huge midline radicular cyst of a 52 years lady who presented with increasing size of swelling at the midline of the upper lip region which makes patients ugly for 25 years. It leads to the mass effect at the philtrum of the upper labium at midlines leads to elevation and ugly looking face making her socially embarrassing. Endoscope-assisted complete excision was performed via midline mini visor incision and with no evidence of recurrence found at three-month follow-up.</p> Brihaspati Sigdel Kuseshwar Sah Bhima Neupane Copyright (c) 2022 Brihaspati Sigdel, Kuseshwar Sah, Bhima Neupane https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1826 1829 10.3126/bjhs.v7i2.49309 Compound odontoma: A case report on 42 denticles hodgepodge in maxilla https://www.nepjol.info/index.php/bjhs/article/view/49310 <p>Compound odontomas are the commonest benign odontogenic tumours of jaws affecting mostly children and adolescents. These developmental malformations display many tooth-like structures or denticles that consist of well-defined dental tissues with diverse morphologies. Majority of these lesions occur as intraosseous masses in the maxillary anterior region and are incidental radiographic findings. These are primarily associated with retention of primary teeth and delayed eruption of permanent teeth. The preferred treatment for these lesions is conservative surgical excision followed by a histopathological diagnosis. This case report presents a rare case of compound odontoma displaying numerous denticles (42 in number) in the maxillary anterior region of a 12-year-old male child and its surgical management.</p> Sneha Shrestha Amita Rai Bandana Koirala Mamta Dali Ashish Shrestha Copyright (c) 2022 Sneha Shrestha, Amita Rai, Bandana Koirala, Mamta Dali, Ashish Shrestha https://creativecommons.org/licenses/by/4.0 2022-11-18 2022-11-18 7 2 1830 1833 10.3126/bjhs.v7i2.49310