Nepal Mediciti Medical Journal最新文献

{"title":"Limberg flap as a Primary Treatment for Pilonidal Sinus at Nepal Mediciti Hospital: A Single Unit Experience","authors":"S. Ghimire, Sunil Dhakal, P. Rai, Nirvan Rai","doi":"10.3126/nmmj.v2i2.41277","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41277","url":null,"abstract":"INTRODUCTION: Pilonidal Sinus is a common condition with estimated incidence of 260 per million population with more male predilection and is often seen in sacrococcygeal area but has also been described in other areas with hair. The Limberg rhomboid flap was designed by Limberg in 1946 for the closure of a sixty degree rhombus shaped defect with a transposition flap. We would like to share our single unit experience of Rhomboid Limberg flap for Pilonidal sinus in our hospital. METHODS: This is an ongoing prospective descriptive study in the Department of General Surgery and Digestive Diseases of Nepal Mediciti Hospital from October 2018. The demographic of the patients, presenting symptoms, duration of symptoms and previous interventions are recorded and the Rhomboid Limberg flap surgery is done under regional or general anesthesia in prone position. The patient is given intravenous antibiotic and is instructed to sleep laterally or in prone position for 24 hours. The dressing is removed and the wound is inspected for flap status in the next morning. The patient is discharged on 1st post-operative day on oral antibiotics for 7 days and is followed on 7th post-operative day for removal of suction drain and alternate sutures in the skin and remaining sutures are removed on 10th post-operative day. RESULTS: We have done 28 cases of Limberg flap for Pilonidal Sinus from October 2018 to December 2020 of which 24 were male patients. None of our patients had flap necrosis. One patient presented with accidental removal of suction drain on 5th postoperative day, however he didn’t develop any wound related complication. One patient had superficial wound dehiscence on 10th post-operative day which healed on its own with dressing. One patient developed seroma from 5th postoperative and was managed with dressing and antibiotics and it healed in 2 weeks. None of our patients have developed recurrence and their wounds have healed satisfactorily with minimal scarring and pain. All the patients were able to resume their regular activities within 21 days. All except 2 patients were satisfied with cosmetic outcome. CONCLUSION: The Limberg flap is ideal treatment for pilonidal sinus with minimal postoperative pain, short hospital stay, few complications, rapid return to normal activities, good cosmesis, and a low recurrence rate with short learning curve for young surgeons. Hence, Limberg flap should be routinely used as primary treatment for pilonidal sinus.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132106631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Contact Lens Practices during Coronavirus (COVID-19) Pandemic","authors":"S. Bhattarai","doi":"10.3126/nmmj.v2i2.41286","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41286","url":null,"abstract":"World is threatened by different variants of Coronavirus to an extent that life has been jeopardized in all services including eye care facility. Contact lenses which are one of the preferred modes of vision correction are not an exception to COVID-19 infection. Recently there is confusion among practitioners and patients regarding the safety of contact lens use during COVID-19. This review article summarizes the current recommendations and findings regarding contact lens use during COVID-19. Though eye health professionals and contact lens users are at risk to contract Coronavirus, with proper care, maintenance and disinfection techniques, it would be safe to continue wearing contact lenses. There is currently no strong evidence to suggest that contact lenses are not safe to wear during COVID 19 times. Eye care practitioners responsible for contact lens application must wear special surgical masks, protective glasses or visors and disposable waterproof gloves. Regarding soft contact lenses, preferably daily disposable lenses should be used from the sterile packages. Similarly for rigid gas permeable lenses, lenses made up of fluoropolymer contained in sealed packages must be motivated for the individuals. Since the infected hands can bring the virus to the eyes, contact lens users should avoid touching the nose, mouth and eye unnecessarily. Contact lens after each use must be disinfected with hydrogen peroxide solutions with a special catalyst container. In the case of eye redness and Flu like symptoms, contact lens trial and wearing practices should be suspended or postpone till the condition becomes normal. To minimize the contact time between the patient and examiner soft copy of the instruction sheet, teleconsultation should be motivated. Though the eye is an unlikely site for Coronavirus infection, eye doctors should warn the contact lens wearers to follow scrupulous contact lens hygiene rules.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127463754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature.","authors":"A. Shrestha, S. Bhattarai, S. Shrestha, M. Chand, A. Bhattarai","doi":"10.21203/RS.3.RS-618682/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-618682/V1","url":null,"abstract":"\u0000 Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129031297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Nonalcoholic Fatty Liver Disease and Vitamin D in Nepal","authors":"M. Sah, R. Shrestha, B. Shrestha, D. Khadka","doi":"10.3126/NMMJ.V2I1.37217","DOIUrl":"https://doi.org/10.3126/NMMJ.V2I1.37217","url":null,"abstract":"Background and Aims: Vitamin D deficiency has been frequently reported in many causes of chronic liver disease and has been associated with the development and evolution of non-alcoholic fatty liver disease (NAFLD).The study was done to explore associations between serum vitamin D concentrations among obesity, diabetes mellitus, hypothyroidism, and metabolic syndrome and its effects on liver fibrosis by ultra-sonogram and 2 d shear wave elastography in patients with non-alcoholic fatty liver disease (NAFLD). \u0000Methods: A hospital based prospective observational study was conducted from May 2019 for twelve months period in Gastroenterology Unit, NAMS, Nepal. Seventy patients with known fatty liver identified by Ultrasonogram criteria were enrolled. All patients were evaluated by different fibrosis scores (NAFLD Fibrosis, FIB4, APRI, AST/ALT ratio) and 2d shear wave score. Patients were evaluated for Vitamin D level and its effects on obesity, diabetes mellitus, thyroid related disease, dyslipidemias and NAFLD. \u0000Results: Among 70 patients, 39 (55.7%) were male and 31 (44.3%) were female with mean age of 44.3 years. Most of the patients were overweight with mean BMI of 28.2 kg/m2; among them 51 (72.9%) were more than 25.kg/m2. About 41.4% had diabetes mellitus, 77.1% had hypertension, 30% had hypothyroidism and 25.9% had metabolic syndrome. Majority of patients on ultrasound grading were mild with 64.28%; 25.72% were moderate and only 10 % were in severe groups. A study of 2 d shear wave elastography showed mean fibrosis of 7.07 kpa for mild grade, 8.22 kpa for moderate grade and 18.16 kpa for severe grade. The mean value of vitamin D was 22.61iu/ml for mild grade, 24.89 iu/ml for moderate grade and 17.4 iu/ml for severe grade. \u0000Conclusion: The results of this study showed high prevalence of serum 25(OH) vitamin D inadequacy in individuals with obesity, diabetes mellitus, hypothyroidism and metabolic syndrome which worsens as the stage of liver disease progresses.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122866458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforated Appendicitis Treated By Open Versus Laparoscopic Surgery- A Comparative Study","authors":"B. Timilsina, O. Karki, B. Subedi","doi":"10.3126/NMMJ.V2I1.37215","DOIUrl":"https://doi.org/10.3126/NMMJ.V2I1.37215","url":null,"abstract":"Background: Acute appendicitis is the most common surgical emergency of the abdomen. Perforated appendicitis often has higher morbidity and mortality. Laparoscopic Appendectomy (LA) is safe and effective procedure for the simple appendicitis compared to Open Appendectomy (OA) but it is not considered as the first line approach in case of perforated appendicitis and its role is still controversial and is under investigation. Hence this study was carried out to compare the outcomes of LA over OA in proven cases of perforated appendicitis. \u0000Methods: A hospital based comparative study was conducted among 60 patients with the diagnosis of perforated appendicitis who underwent LA and OA, for a duration of 18 months in Manipal Teaching Hospital, Pokhara. Data were collected using semi-structured questionnaire and were analyzed by descriptive and inferential statistics with SPSS version 25.0. \u0000Results: The study showed no significant statistical difference in operative time in LA compared to OA (66±18.11 minutes vs. 66.67±25.269 minutes, p = 0.9). Moreover it shows less post-operative pain (p = 0.003), shorter length of hospital stay (5.3±1.8 days vs. 7.3±3.31 days, p = 0.005), faster return of peristalsis (1.43±0.504 days vs 1.80±0.805 days, p = 0.037) and faster reinstitution of liquid diet(1.43±0.504 days vs 1.80±0.805 days, p = 0.037), less incidence of wound infection (5 in 30 = 16.66% vs. 12 in 30 = 40%, p = 0.042) and faster subjective full recovery(1.9±0.759 weeks vs. 2.9±0.89 weeks, p ˂ 0.0001) of LA patient compared to OA which is statistically significant. \u0000Conclusion: LA is safe and effective procedure than OA for perforated appendicitis.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115937623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}