Journal of Nepalgunj Medical College最新文献

{"title":"Harmless Acute Pancreatitis Score","authors":"S. Bharti, Anup Sharma","doi":"10.3126/jngmc.v19i1.40227","DOIUrl":"https://doi.org/10.3126/jngmc.v19i1.40227","url":null,"abstract":"Introduction: Acute Pancreatitis is a common disease in our region. It can range from mild to severe disease with high mortality rate. It is critical to identify patients who are at high risk for a severe disease course, since they require close monitoring and immediate aggressive treatment. \u0000Aims: To compare the effectiveness of Harmless Acute Pancreatitis Score with Ranson’s scoring system in predicting the severity of Acute Pancreatitis. \u0000Methods: A prospective cross sectional study was done among 45 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. If haematocrit was less than39% in female and less than43% in male, serum creatinine less than two miligram /deciliter and no sign of peritonitis, it was assigned as Harmless Acute Pancreatitis Score Zero. If at least one parameter was abnormal it was assigned as Harmless Acute Pancreatitis Score +. Severe pancreatitis (poor prognosis) was considered in those who required Intensive Care Unit care, who had in hospital mortality and who had hospitalization of more than five days. Patients with on admission Ranson’s score of more than three were suspected to have severe Pancreatitis. \u0000Results: There were total 45 patients, 18 females and 27 males. Twenty four patients were assigned as Harmless Acute Pancreatitis Score zero and 21 patients were assigned as Harmless Acute Pancreatitis Score +. Harmless Acute Pancreatitis Score was able to predict correctly in 18 out of 26 patients who fulfilled the criteria of poor prognosis (p<0.001). \u0000Conclusion: Harmless Acute Pancreatitis Score proved to be a better screening tool compared to on admission Ranson’s scoring system to predict the severity of Acute Pancreatitis, which may help predict the prognosis of the patient.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114401364","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":"Correlation between McIssac Score and Throat Swab Culture in Patient Presenting with Acute Tonsillitis","authors":"S. Bhandari, D. Paudel, K. Gurung","doi":"10.3126/jngmc.v19i2.42994","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42994","url":null,"abstract":"Introduction: Tonsillitis is inflammation of tonsils which is characterized by various signs and symptoms with sore throat being the most consistent symptom. The condition is mostly caused by bacterial infection with Streptococci being the most common bacteria. McIssac scoring technique is clinical symptoms based scoring method designed for diagnosing streptococcal tonsillitis.\u0000Aims: To find out the association between McIssac Score and beta hemolytic streptococcal infection in acute tonsillitis.\u0000Methods: This hospital based, prospective study was carried out in the Department of ENT, Nepalgunj Medical College from July 2020 to June 2021. Patients were scored as per McIssac score. The specimens were collected from the tonsillar surface using sterile cotton swabs and subjected for culture and sensitivity.\u0000Results:The most common affected age group was 21 to 30 years (46%). Females were affected more commonly (57%). The most common organism isolated in the study was Group A beta hemolyticn Streptococcus (48%), followed by Pseudomonas (10%), Enterococcus (9%) and Klebsiella (8%) and no organisms were isolated in 25% of the patients. It was observed that high McIssac score was associated with higher chance of having positive beta hemolytic streptococcal infection. Out of 48 group A beta hemolytic streptococci culture positive patients 18(37.5%) patients scored 3, 9 (18.75%) patients scored 4 and 7(14.5%) patients scored 5.The most common antibiotic effective against group A beta hemolytic srtreptococci was ceftriaxone in 25(72.9%), followed by amoxyclavulinic acid in 20 isolates (41.6%) and amikacin in seventeen (35.4%) isolates.\u0000Conclusion: The correlation between throat swab culture and McIssac score emphasized that this clinical scoring system aid in early diagnosis of group A beta hemolytic streptococci tonsillitis.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116801876","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":"Outcome of Management of Pediatric Subtrochanteric Femoral Fracture with Broad Dynamic Compression Plate and Proximal Cancellous Screw through the Femoral Neck","authors":"P. Karki, D. Shrestha, Roshani Ranabhat","doi":"10.3126/jngmc.v19i2.42987","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42987","url":null,"abstract":"Introduction: Pediatric subtrochanteric femoral fracture can be managed with traction followed by spica, intramedullary elastic nailing, plating or external fixators. The prognosis largely depends on adequate reduction and stable fixation.\u0000Aims:The aim of this study was to evaluate functional outcome of pediatric subtrochanteric femoral fracture treated with broad dynamic compression plate.\u0000Methods: This prospective observational study consisted of 32 children between the age 7 to 15 years, with an average of 10.06 years ± 2.29, with subtrochanteric femoral fracture. Fractures were reduced by an open reduction through lateral approach and stabilized with a broad dynamic compression plate along with a proximal cancellous screw through the femoral neck. All patients were followed for 15 months and the results were evaluated on the basis of Flynn scoring system.\u0000Results: All fractures united with a mean duration of 12.6 weeks ± 0.91. Average hospital stay was 8.43 days (5 to 14 days). Functional outcome was excellent in 84.38% (27 patients) and satisfactory in 15.62% (5 patients). Full weight bearing was started after mean duration of 16.62 weeks ± 0.91. Implants were removed at an average of 11.21 months ± 1.06. There were no significant limb length discrepancies, deep infections, re-fracture, osteomyelitis and avascular necrosis.\u0000Conclusion: This prospective study showed good functional outcome in pediatric patients having subtrochanteric femoral fractures who were treated with a broad dynamic compression plate and a proximal cancellous screw through neck.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123815712","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":"Effectiveness of Modified Tension Band Wiring for Medial Mallelous Fracture of Tibia","authors":"Dipendra Kc, D. Shrestha, P. Karki, Sushil Yogi","doi":"10.3126/jngmc.v19i2.42998","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42998","url":null,"abstract":"Introduction: Medial malleolus fracture is one of the commonest fractures. Non-operative approach may fail to produce anatomical reduction leading to ankle instability, nonunion and post traumatic osteoarthritis of the ankle. Proper anatomical reduction and stable internal fixation remains the key in treatment of displaced fracture. Good result had been achieved with Modified Tension Band Wiring.\u0000Aims:The purpose of our study was to evaluate the functional outcome of medial malleolus fracture treated with modified tension band wiring.\u0000Methods:This prospective observational study was conducted in department of Orthopaedics of Nepalgunj Medical College and Teaching Hospital from September 2018 to August 2021. Patients were evaluated for mode of injury, type of fracture, associated injury, radiological union, functional outcome, accompanying complications. All of the medial malleolus fractures in this study were treated by modified tension band wiring and outcomes were evaluated using Olerud and Molander Score.\u0000Results: In this study of 40 patients with the mean age of 41.60+13.75 year, 31(77.5%) were male and 9 (22.5%) were female. Majority of fractures were observed between 35 to 44 years, right side was predominantly involved, road traffic accident was the most common mode of injury. The average time duration of surgery from the time of injury was 5.25 days. Final functional outcome as per Olerud and Molander score showed, seven (17.5%) patients had excellent results, 30 (75%) patients had good results and three (7.5%) patients had poor results. The most common complication noted was hardware prominence at 7.5%, followed by superficial wound infection in 5% of patients.\u0000Conclusion: Modified Tension band wiring of medial malleolus results in good to excellent outcome in most of the patients with few complications .","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130572205","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":"Comparative Study between Conservative Management and Appendectomy in Appendicular Lump in Children","authors":"Feeroz Alam Khan, N. Paudel, P. Maharjan","doi":"10.3126/jngmc.v19i2.42859","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42859","url":null,"abstract":"Introduction: Acute appendicitis is the most common presentation in the pediatric emergency department. Presentation ranges from mild inflammation to perforation and peritonitis. Frequently, patients present late with lump formation. Traditionally, an appendicular lump is managed conservatively followed by interval appendectomy six weeks later when the inflammation has resolved.\u0000Aims: This study was designed to evaluate the outcome of early appendectomy in cases of appendicular lump and their complications compared to the conventional method of conservative management followed by interval appendectomy.\u0000Methods: A prospective comparative study was conducted between November 2018 and October 2021. All the patients with appendicular lump of up to 7 days duration diagnosed clinically or by ultrasonography were randomly divided into two groups. Group I patients were conservatively managed as per the Ochsner-Sherren regimen. Patients in Group II were operated within 24 hours of admission. Mean operative time was recorded in each case. Complications following the respective interventions were observed.\u0000Results: Sixty-two patients of which 42 males and 20 females were diagnosed to have an appendicular lump. The age of the patients ranged from seven to 15 years. Duration of onset ranged from three to seven days at the time of presentation in the emergency room. All the patients in Group I except two patients underwent conservative management. There were four readmissions among Group I patients and one in Group II. The average operating time was 67 minutes for patients undergoing open appendectomy. Complications following surgery were more in patients presenting with history of over five days duration. Group I patients had a comparatively greater number of hospital admission days compared to Group II (7.1 and 4.8 days).\u0000Conclusion: The appendicular lump can be explored early as it confirms the diagnosis, shortens the financial burden and hospital stay and avoids follow-up visits for interval surgery.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"11 21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128529844","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":"Comparative Study of Minimally Invasive Percutaneous Plate Osteosynthesis versus Reamed Intramedullary Nail Fixation for Extra Articular Distal Third Tibial Fractures","authors":"D. Shrestha, Dipendra Kc, P. Karki, S. Shrestha, Sushil Yogi","doi":"10.3126/jngmc.v19i2.42991","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42991","url":null,"abstract":"Introduction: Extraarticular distal third tibial fractures are highly controversial and difficult to treat despite of numerous methods of fixation. The most common methods of treating these fractures are minimally invasive percutaneous plate osteosynthesis (MIPPO) and reamed intramedullary nailing (RIMN).\u0000Aims: The aim of this study is to compare and assess its demographic status, preoperative status and functional outcomes of these two groups of patients with extraarticular distal third tibial fractures.\u0000Methods:This prospective hospital based observational study of 36 patients with extra articular distal third tibial fractures was carried out from January 2018 to January 2021 at Nepalgunj Medical College Teaching Hospital, Kohalpur. Thirty-six patients were included in the study and were divided into two groups of 18 each and were treated with MIPPO and RIMN methods and were followed up regularly. Clinical and functional outcome were evaluated at 12 months.\u0000Results: Out of 36 patients 20 were male and 16 were female. Mean age was 37.63with SD ± 11.43 years. Twenty two were right sided and 14 were left sided. Mean duration of surgery in MIPPO group was 75.33 with SD ± 14.64minutes and in RIMN group was 98.33with SD ± 18.96 minutes. There were 24 cases of associated fibular fractures. Two cases of surgical site infection and two cases of K-wire impingement on fibular side were encountered in MIPPO group whereas three cases of postoperative blisters were seen in RIMN group. All fractures united. The mean average time for fracture healing in MIPPO group was 25.55 weeks and in RIMN group was 27.55 weeks. The clinical and functional outcome were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) scoring system, the mean score in MIPPO group was 91.22 and in RIMN group was 90.77.\u0000Conclusion: There was a good outcome in MIPPO group than RIMN group for extra articular distal third tibial fractures.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126433675","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":"Outcome of Pediatric Humerus Fracture Treated With Close Reduction and Elastic Intramedullary Nailing","authors":"Sushil Yogi, D. Shrestha, Dipendra Kc, P. Karki, S. Shrestha","doi":"10.3126/jngmc.v19i2.42993","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42993","url":null,"abstract":"Introduction: Pediatric humeral shaft fractures are infrequent fractures only secondary to trauma or any of the pathological changes in the bone; representing two to 5.5% of all pediatric fractures and occurring predominantly in children younger than three years or older than 12 years of age. These fractures can usually be treated conservatively with functional bracing and splints however conditions like inability to maintain an acceptable reduction, open fractures, floating elbow, closed head injury, and polytrauma patient requiring early weight bearing warrant the surgical intervention. The intramedullary elastic nails have been found to be more effective in treating fracture shaft of humerus of pediatric age group in comparison over other implants used.\u0000Aims:The aim of this cross-sectional observational study was to evaluate the outcome of shaft of humerus fracture in children treated with retrograde intramedullary kirschner’s wire.\u0000Methods: This prospective study was conducted in the department of Orthopedics in Nepalgunj Medical College Teaching, Kohalpur from January 2020 to March 2021 in 26 children. Children were evaluated for age, sex, side of injury, mechanism of injury, time period for union, implant removal time, outcome and accompanying complications. Patients were evaluated using Broberg and Morrey scoring system for elbow functions and modified Dash criteria for shoulder function.\u0000Results: In this study of 26 children, 65.4% were boys and 34.6% were girls with average age of 9.58 ± 2.1 years. Left side was prominent side for injury with 69.2%. The average duration for union was found to be 10.04 ± 1.42 weeks. The implant was removed at 24.19 ±1.57 weeks. Based on Broberg and Morrey score system for elbow, 23 (88.46%) children had excellent result and three (11.54%) had good result. While evaluating for Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder joint evaluation; all children had excellent result.\u0000Conclusion: The treatment of pediatric humeral shaft fracture by close reduction and intramedullary kirschner’s wire is safe, easy and cost effective operative procedure with good results.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131182497","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":"Evaluation of Bacterial Co-infections of the Respiratory Tract in COVID-19 Patients","authors":"K. Gurung, P. Pant, Sandeep Pokhrel, Dhan Raj Neupane, Samjhana Gurung","doi":"10.3126/jngmc.v19i2.42851","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42851","url":null,"abstract":"Introduction: The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2. The co-evolution of viral and bacterial respiratory pathogens has created an environment in which a viral infection allows concurrent or secondary bacterial co-infections.\u0000Aims: This study was carried out to isolate the different respiratory bacterial pathogens from COVID patients and evaluate their antibiotic sensitivity pattern.\u0000Methods: Hospital based descriptive cross sectional study was conducted over a period of between 2nd Jestha to 5th Shrawan 2078 (16th May to 20th July 2021) in Nepalgunj Medical college, Kohalpur during the second wave of COVID-19 in Nepal. The sputum was inoculated onto different culture plates such as Blood Agar (BA) and MacConkey Agar (MA) and incubated at 37 oC. After overnight growth and in Gram staining, different Gram’s positive and negative bacteria were observed. Antibiotic sensitivity test was performed by Kirby-Bauer Disk Diffusion method.\u0000Results: Out of 100 sputum samples, 44% positive bacterial growths, majority isolates were Klebsiella spp and Staphylococcus aureus. Overall, the pathogens were mostly sensitive to meropenem followed by colistin, piperacilin/tazobactam respectively.\u0000Conclusion: Bacterial co-infection is common in hospitalized patients with SARS-CoV-2.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125609164","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":"Distal Humeral Diaphyseal Open Fracture in a Child with Bone Loss","authors":"S. Shrestha, D. Shrestha","doi":"10.3126/jngmc.v19i2.43005","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.43005","url":null,"abstract":"Distal diaphyseal humerus fracture is less common than supracondylar humeral fracture and its open fracture is even less. This is a case report of open distal humeral diaphyseal fracture on the left arm with bone loss in 10 years old male who sustained the injury from fall, diagnosed as Grade III open unstable distal diaphyseal shaft fracture of left humerus with bone loss without neurovascular deficit. We performed Open Reduction /Internal Fixation (OR/IF) and free bone fragment was flipped and fixed to the bone fragments and maximum possible contact was made and fixed with an external fixator. Range of motion was advised as early as possible. At final follow up the result was excellent as per Flynn's criteria. OR/IF (Open Reduction /Internal Fixation) of this fracture with posterior approach and flipping the bone to get more contact seems good and safe procedure. Further, external fixation provides reasonable fixation in these cases.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133555576","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":"Unusual Case of Foreign Body Ingestion in a Child: A Case Report","authors":"S. Nag","doi":"10.3126/jngmc.v19i2.43006","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.43006","url":null,"abstract":"Foreign body ingestion is a common problem in pediatric age group patients throughout the world. Radiographic findings revealed multiple foreign bodies throughout abdomen. Foreign objects attach frequently at the esophageal anatomic narrowing. They must be taken out immediately because they can cause an obstruction, mucosal erosion or perforation. Endoscopy is the criterion standard for removal of foreign bodies from the esophagus. Here, we report an interesting case of a multiple stones ingested by a female child. The child presented with complaints of distension of abdomen, vomiting and pain all over abdomen. The foreign bodies were found as hard black stones after removing them through anal route.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130104485","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}