Grande Medical Journal 2020-01-10T10:15:15+00:00 Dr Rupendra Bahadur Adhikari, MD, PhD Open Journal Systems <p>Grande Medical Journal is a bi-annual, open, peer-reviewed interdisciplinary journal published by the Academic and Research Department, Grande International Hospital, Dhapasi, Kathmandu, Nepal.</p> Comparison of single shot caudal Ropivacaine and Bupivacaine in paediatric patients undergoing herniotomy 2020-01-10T10:15:15+00:00 Rishabh Ravi Bigen Man Shakya Anil Shrestha Megha Koirala <p><strong>Background:&nbsp;</strong>Inguinal hernia repair is a common surgical procedure in children. Caudal block is an appropriate technique for the treatment of post operative pain in children undergoing herniotomy. This study compared the effects of Ropivacaine and Bupivacaine in caudal block in children undergoing herniotomy.</p> <p><strong>Methodology:&nbsp;</strong>A total of 74 patients between 5-16 yrs undergoing herniotomy were randomized in two groups. In Group B, 0.75ml/kg of 0.25% caudal Bupivacaine was administered whereas Group R received 0.75 ml/kg of 0.25% caudal Ropivacaine. Pain score was assessed using Wong Baker pain scale in post operative period and motor power was assessed using modified Bromage scale till 6 hours.</p> <p><strong>Results:&nbsp;</strong>The mean duration of post operative analgesia was found to be 253.51 ± 11.48 minutes in Bupivacaine and 258.1 ± 12.10 minutes in Ropivacaine group. The median duration of motor block was 180 (Q1 60- Q3 180) minutes in Bupivacaine and 30 (Q1 22.5- Q3 45) minutes in Ropivacaine group which was statistically significant. There was complete recovery of motor block by 2 hour in Ropivacaine and by 4 hour in Bupivacaine group. (p value&lt; 0.001).</p> <p><strong>Conclusion:&nbsp;</strong>From the current study, it is concluded that caudal Ropivacaine at 0.25% concentration and 0.75ml/ kg provides similar duration of post operative analgesia with less motor block in comparison to Bupivacaine.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Life style factors associated with the risk of type 2 diabetes mellitus 2020-01-09T12:14:10+00:00 Bikash Shrestha Bipin Nepal Yagya Laxmi Shakya Binaya Regmi <p>&nbsp;<strong>Introduction:&nbsp;</strong>Type 2 diabetes mellitus is the commonest form of diabetes affecting more than 90% of the diabetic population worldwide. The prevalence of type 2 diabetes and its complications are increasing in the world, including developing nations like Nepal. This study aimed to determine the association between the lifestyle risk factors and the risk of type 2 diabetes mellitus in Nepalese population.</p> <p><strong>Methods:&nbsp;</strong>This is hospital based cross sectional observational study done in the urban area of Nepal. Records of clients coming for the general health checkup in Grande International Hospital were evaluated in this study. Comparisons of the lifestyle factors in participants having and not having type 2 diabetes mellitus were done.</p> <p><strong>Results:&nbsp;</strong>Significant associations with diagnosis of diabetes mellitus (DM) type 2 were seen in age (P ≤ 0.001), associated hypertension (P ≤ 0.001), dyslipidemia, family history of DM (P ≤ 0.001), alcohol use (P ≤ 0.001), and tobacco use (P ≤ 0.001). Logistic regression analysis showed that the odds of having diabetes were high in age group above 40 (OR – 6.9, CI 3.82 – 12.47), history of hypertension (OR- 3.84, CI 2.42 – 6.08), tobacco users (OR-2.26, CI 1.12 – 4.53), alcohol users (OR-3.99, CI 2.47 – 6.44), family history of DM (OR-2.44, CI 1.53 – 3.89), and abdominal obesity in both males (OR-3.9, CI 2 – 7.4) and females (OR-9.6, CI 3.78 – 24.35).</p> <p><strong>Conclusions:&nbsp;</strong>The modifiable risk factors - obesity, smoking and alcohol use carry significant risks of developing type 2 diabetes. These red flag signs call for urgent attention to look for and rectify the modifiable risk factors in Nepalese population to prevent diabetes.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Pattern of sexually transmitted infections in a tertiary care hospital: A five-year retrospective study 2020-01-09T12:14:12+00:00 Anupama Karki Rushma Shrestha Niraj Parajuli <p>&nbsp;<strong>Introduction:&nbsp;</strong>Sexually transmitted infections (STIs) have a profound impact on sexual and reproductive health worldwide and especially in a developing country like Nepal. However, adequate studies are lacking in our context with regards to the pattern analysis of the STIs in community and in the tertiary care hospitals. The aim of this study is to understand the prevalence and pattern of different STIs in Nepal.</p> <p><strong>Methods:&nbsp;</strong>This is a retrospective observational study in which the record of all patients who attended the STD OPD of NAMS, Bir Hospital from 2071 to 2075 B.S. (April 2014 – March 2019) have been analyzed.</p> <p><strong>Results:&nbsp;</strong>Among the 2658 patients who visited the STD OPD, majority (27.5%) had been diagnosed with syphilis. The second commonest diagnosis was condyloma acuminata accounting for 22.6 % of cases. Urethral discharge syndrome and vaginal discharge syndrome comprised of 20.1% and 17% respectively. Genital herpes constituted 6% of cases whereas genital molluscum contagiosum comprised of 3.4% of cases. Genital ulcer diseases accounted for 2.1% of total cases.</p> <p><strong>Conclusions:&nbsp;</strong>There was a high magnitude of STIs found in this study, among which syphilis constituted the major burden. The results of this study also urge further awareness programs regarding the clinical features and importance of early treatment of STIs.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal ABO blood group discrepancies: Study of prevalence and related factors 2020-01-09T12:14:13+00:00 Bipin Nepal Bikash Shrestha Sabindra Maharjan Sunil Bhasima Shrawan Kumar Shrestha <p><strong>Background: </strong>ABO discrepancy is any deviation from the expected pattern of red cell antigen grouping with serum-grouping or when the forward-grouping results do not correlate with reverse-grouping results. This study was done to determine the incidence and causes of ABO discrepancies and to identify the correct blood group for safe blood transfusions.</p> <p><strong>Methods: </strong>This is a retrospective descriptive study. It was done on 9970 samples collected between June 2017and May 2018. All ABO typing records kept at the Grande International Hospital (GIH) blood bank laboratory were reviewed.</p> <p><strong>Results: </strong>During the study period, 9970 blood grouping tests were performed. ABO discrepancies occurred in 26 of them. Discrepancies were more prevalent in the age of 20-30 and 30-40 years. Majority were seen in patients with history of pregnancy/miscarriage (30%) and with any Carcinoma (23%). The most common blood group involved was B with 34% frequency. 96% were reverse discrepancy type, 84% with extra antibody which was resolved by incubating the sample at 37°C for 30 minutes signifying most probably A and B subgroups and auto/allo antibodies.</p> <p><strong>Conclusion: </strong>This study emphasizes the need of considering ABO discrepancies in blood banks for donors and recipients for safe blood transfusion to avoid any fatal complications. This discrepancy ratio of 1/384 is more than in other studied population of other countries and also higher than ABO mismatched transfusion in standard centers in Nepal. Repeat testing and investigating for ABO subgroups and auto/allo antibodies is important.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Preliminary assessment of knee laxity after anterior cruciate ligament reconstruction using bone patellar tendon bone and hamstring graft 2020-01-09T12:14:15+00:00 Chakra Raj Pandey Rajiv Baral Sunit Dahal Sushil Sharma Aayush Bajracharya Ram Thapa <p>&nbsp;&nbsp;<strong>Introduction:&nbsp;</strong>Laxity after anterior cruciate ligament reconstruction is one of the troublesome problems lasting many years. Laxity can be tested by clinical and arthrometer preoperatively as well as postoperatively. The purpose of this study is to evaluate postoperative laxity in Nepalese population.</p> <p><strong>Materials &amp; methods:&nbsp;</strong>This retrospective study was carried out in Grande International Hospital, Kathmandu. All cases which had completed six-months follow up and presented in outpatient department were included in the study. Laxity was tested by Karl Storz Arthrometer using anterior force in 20 degrees of knee flexion with maximum manual force by the same doctor. The statistical significance level was set at p=0.05. Statistical analysis was done using SPSS 16.</p> <p><strong>Results:&nbsp;</strong>21 cases operated via arthroscopic method were eligible for the study. Mean age was 28.3±10.44. There were 14 (66.7%) male 7 (33.3%) female. A total of eight cases of laxity (36.36%) were identified - six males (75%) and two females (25%). Hamstring grafts accounted for three cases of laxity (37.5%) while Bone Patellar Tendon Bone Graft (BPTB) accounted for five cases (62.5%). The mean follow-up was one and half years. Hamstring and bone patellar tendon bone graft were used in 6 (28.6%) and 15 (71.4%) cases respectively.</p> <p><strong>Conclusion:&nbsp;</strong>Previous studies have concluded that &gt;3mm of laxity difference is associated with difficulties in vigorous activities. However, our patients were comfortable in their daily activities without significant clinical outcome.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Prescribing pattern and utilization of selected antimicrobials in a tertiary hospital of Nepal 2020-01-09T12:14:16+00:00 Upasana Acharya Ravi Mahat Subhash Prasad Acharya Bishnu Pahari Prashant Tripathi <p>&nbsp;<strong>Introduction: </strong>This study was done to understand the purpose of using higher grade antimicrobials in a one year period and to compare the consumption of commonly prescribed parenteral antimicrobial agents in four consecutive years in a tertiary care hospital of Nepal.</p> <p><strong>Materials &amp; Methods: </strong>A retrospective observational study was carried out to collect the information on prescription of selected six classes of antimicrobial for all admitted patients aged 2 years or above for a one-year period. Further, the antimicrobial consumption tool 2016 was used to calculate defined daily dose (DDD) per 100 bed days of commonly dispensed parenteral antimicrobials for four consecutive years.</p> <p><strong>Results: </strong>A total of 2568 antimicrobial supply forms prescribing higher grades antimicrobials were analyzed. The indications for use of antimicrobials were mainly for empiric treatment. Among the infections being treated, lower respiratory tract infection (LRTI) was the most frequent cause. Piperacillin-tazobactam was most frequently prescribed followed by Meropenem. Also, DDD for commonly used parenteral antimicrobials showed increasing trends over four consecutive years.</p> <p><strong>Conclusion: </strong>The prescription of higher grades of antimicrobial for empiric treatment and surgical prophylaxis need to be monitored. The rate of consumption of such antimicrobials could not be assessed due to lack of similar studies but the increase in DDD/100 bed days each year suggested the rise in consumption of antimicrobial in the same institution.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Surgical outcome of intradural extramedullary spinal cord tumors - Our experience at a tertiary health care center 2020-01-09T12:14:18+00:00 Gyanendra Joshi Binod Bijukachhe Javed Ahmad Khan <p><strong>Introduction: </strong>To report the treatment results of 19 patients who underwent excision of intradural extramedullary (IDEM) spinal tumors.</p> <p><strong>Materials &amp; Methods: &nbsp;</strong>This is a retrospective study. Patients’ records were retrieved from the electronic database of Grande International Hospital. There were 19 IDEM spinal tumors excised over a period of 6 years between January 2013 and August 2019 by a single surgeon. There were 11 (57.9%) males and 8 (42.1%) females with an average age of 48.37±21.87 years (range, 5-79 years). The mean postoperative follow-up period was 12.87±14.88 months (range, 15 days - 60 months). The histopathological findings, locations of the tumors, and clinical results were analyzed. Neurological findings were evaluated using ASIA grading system and pain was evaluated using VAS score.</p> <p><strong>Results: &nbsp;</strong>Histopathologically the tumors were: 8 meningioma (42.1%), 4 schwannoma (21.1%), 4 neurofibroma (21.1%), 1 dermoid cyst (5.3%), 1 lipoma (5.3%), and 1 myxopapillary ependymoma (5.3%). Tumor locations were: dorsal in 10 (52.6%), lumbar in 5 (26.3%), lumbosacral in 2 (10.5%), dorsolumbar in 1 (5.3%), and cervical in 1 (5.3%) patient. Neurologic status of 7 patients was normal and 12 had neurologic involvement with 3 patients having Cauda Equina Syndrome (CES) preoperatively. At the final follow-up, 3-grade, 2-grade and 1-grade improvement in ASIA score was observed in 1, 6 and 1 cases, respectively. There was no change in the ASIA grade in 1 case. All 3 cases of CES achieved full neural recovery. Preoperative VAS score was 9.21±1.08 and improved significantly to 0.74±1.62 after surgery. Neurological improvement was seen in 91.67% with complete recovery in 75% of the cases and not a single case deteriorated neurologically post-surgery.</p> <p><strong>Conclusion: &nbsp;</strong>Most intradural-extramedullary spinal cord tumors are mostly benign and good clinical results can be obtained when adequately treated with surgery.</p> 2020-01-05T00:00:00+00:00 Copyright (c) 2020 Grande Medical Journal Paratesticular rhabdomyosarcoma - A case report 2020-01-09T12:14:29+00:00 Prakash Kayastha Sharma Poudel Rajan Mani Bhandari Prem Raj Gyawali Shova Banstola <p>&nbsp;Rhabdomyosarcoma is a malignant tumor of muscular origin. It comprises the most common soft tissue tumor in children accounting for approximately 5-8% of childhood cancers. Here we present a case of paratesticular rhabdomyosarcoma in a 13-year male child who was referred for ultrasonic examination (USG) to the department of radiology for evaluation of right scrotal swelling with pain for few months. Paratesticular rhabdomyosarcoma is a rare non germ cell tumor of scrotal sac in children and young adult/teens which can invade testis at presentation. We review the epidemiology, histology, clinical presentation, staging and prognosis of paratesticular rhabdomyosarcoma and discuss the role of radiology in their management.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Intradiploic epidermoid cyst of the skull 2020-01-09T12:14:26+00:00 Subash Phuyal Kapil Dawadi Rupendra Bahadur Adhikari <p>Not available.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Hyperdense middle cerebral artery sign 2020-01-09T12:14:27+00:00 Gentle Sundar Shrestha Pankaj Jalan <p>Not available.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Cancer patients in complementary and alternative medicine: More harm 2020-01-09T12:14:08+00:00 Abish Adhikari Rupendra Bahadur Adhikari <p>Not available.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Epidemiological study of spine cases admitted at Grande International Hospital 2020-01-09T12:14:23+00:00 Javed Ahmad Khan Binod Bijukachhe Gyanendra Joshi Ram Krishna Dahal <p>&nbsp;<strong>Introduction:&nbsp;</strong>Our institution is tertiary care centre and referral centre for spine surgery. We like to share the epidemiological parameters of the case treated here.</p> <p><strong>Methods:&nbsp;</strong>This is retrospective, descriptive study conducted from 2013 to August 2018. All the data retrieved from hospital information system of admitted patients and demographic presentations, disease pattern, region of involvement were analyzed.</p> <p><strong>Result:&nbsp;</strong>There were a total of 698 patients. Male were 262(37.5%) and female were 436(62.5%). Age wise distribution ranged from 2 years to 85 years. Maximum numbers of patients were from 31 to 60 years (57.5%) and there were only 3% of cases less than 15 years and above 76 years. 30.2% cases were related to trauma, 29.8% of cases were related to disc pathology, followed by degenerative diseases 13%, infection 9.2%, and 5.4% were of tumors 8.7 % were cases were not classified in the above categories. There were 56.7% cases from lumbosacral region, 16.3% cases from thoracic region, 13.2% cases from cervical region, 5.7% cases were from multiple regions. 0.3% were of generalized nature which could not be classified.</p> <p><strong>Conclusion:&nbsp;</strong>Spinal diseases are more common in female population, more frequent in third to sixth decade of life. Highest numbers of cases were from traumatic cause followed by degenerative disc diseases. Lumbosacral region is most commonly affected.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Prevalence and pattern of hand eczema in a tertiary referral hospital of Nepal 2020-01-09T12:14:25+00:00 Rushma Shrestha Anupama Karki <p>&nbsp;<strong>Background: </strong>Hand eczema is a very common condition that has a significant effect on an individual’s life in terms of daily functioning including various occupations. Studies show that the point prevalence of hand eczema is around 4% and the lifetime prevalence is 15%.</p> <p><strong>Objective: </strong>The objective of this study is to determine the prevalence and pattern of hand eczemas in patients attending the Dermatology outpatient department of Bir hospital.</p> <p><strong>Materials and methods: </strong>This is a retrospective study, where all the cases of hand eczema who presented to the Dermatology Out-Patient Department of Bir Hospital during the period from Baisakh 2075 till Chaitra 2075 B.S were recorded.</p> <p><strong>Results: </strong>Eczema was diagnosed in 5,100 new cases (15.74%) and among them, hand eczema was seen in 494 cases, which accounts for 9.68% of all eczemas. The mean age was 37.43 years. Out of all the hand eczemas recorded, 334 (67.6%) were unspecified hand eczemas, pompholyx was seen in 92 (18.6%) cases, chronic hand eczema in 27 (5.5%), contact dermatitis in 20 (4%) patients and finger tip eczema was seen in 15 (3%) cases.</p> <p><strong>Conclusion: </strong>Hand eczema is one of the common dermatological conditions. Our study showed the prevalence of hand eczema to be 9.68%.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Importance of moisturizers in skin 2020-01-09T12:14:30+00:00 Rushma Shrestha Anupama Karki Niraj Parajuli <p>Not available.</p> 2020-01-06T00:00:00+00:00 Copyright (c) 2020 Grande Medical Journal Comparison of laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: A meta-analysis 2020-01-09T12:14:19+00:00 Sandrie Mariella Mac Ashish Bahadur Malla <p>For many decades, D2 procedure has been accepted in the far-east as the standard treatment for both early (EGC) and advanced gastric cancer (AGC). In case of AGC, the debate on the extent of nodal dissection has been open for many years in order to highlight the safety and efficacy of treatment, hence this study.</p> <p>A comprehensive literature research was performed in PubMed to identify studies that compared laparoscopic- assisted gastrectomy (LAG) and open gastrectomy (OG) with D2 lymph node dissection (D2-LND) for treatment of AGC for the last five years. Data of interest were checked and subjected to meta-analysis with RevMan 5.3 software. The pooled risk ratios (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated.</p> <p>Overall, 19 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD -2.31; 95% CI -4.09 to -0.53; P = 0.01), less blood loss (WMD -120.49; 95% CI -174.27 to -66.71; P &lt; 0.01), faster bowel recovery (WMD -0.55; 95% CI -0.86 to -0.24; P ˂ 0.01) and earlier ambulation (WMD -0.75; 95% CI -1.38 to -0.11; P = 0.02). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.94, 95% CI, -2.95 to 1.06; P=0.36), a lower complication rate [odds ratio (OR)=0.80; 95%CI, 0.68-0.97; P=0.02], and overall survival (OS) and disease-free survival (DFS) comparable to OG.</p> <p>In conclusion, for AGCs both techniques (LAG and OG) appeared comparable in short- and long-term results. More time was needed to perform LAG; nonetheless, it had some advantages in achieving faster postoperative recovery over OG. In order to clarify this controversial issue ongoing trials and future studies are needed.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal Nutrition status of children in Nepal: Analysis from the findings of Nepal Demographic Health Survey 2016 2020-01-09T12:14:21+00:00 Ridesh Pokharel Bibhor Pokharel Rajan Bhusal Deepika Chapagain <p>&nbsp;<strong>Introduction:&nbsp;</strong>Nutrition is simply the process of intake of food which is required according to the body need. A well balanced food with regular physical activity is a foundation for a good health. Some effects in health such as reduced immunity, increased susceptibility to disease, poor physical and mental development and reduction in productive capacity can be seen as a result of poor nutrition. The indicators of nutrition are stunting, wasting, underweight and overweight among the children.</p> <p><strong>Methods:&nbsp;</strong>The 2016 Nepal Demographic Health Survey (NDHS) measured the height and weight of eligible children under age 5 in sample households. Weight measurements were taken from lightweight SECA infant scales with a digital display (model no. SECA 878U), designed and supplied by the United Nations Children’s Fund (UNICEF). Height was measured with a measuring board (Shorr Boards®). Recumbent length was measured for children younger than age 24 months, and standing height was measured for older children.</p> <p><strong>Results:&nbsp;</strong>Overall, 36% of children under age 5 were stunted, with 12% being severely stunted (too short for their age); 10% were wasted, with 2% severely wasted (too thin for their height); and 27% were underweight, with 5% severely underweight (too thin for their age), while around 1% of the children were overweight (heavy for their height).</p> <p><strong>Conclusion:&nbsp;</strong>The different indicators of nutritional status among children such as stunting, wasting and underweight are decreasing. The national program and effective contribution from several non-governmental agencies is the main reason for the improvement in nutritious status.</p> 2019-12-31T00:00:00+00:00 Copyright (c) 2019 Grande Medical Journal