https://hdl.handle.net/20.500.14356/1517 2026-04-23T11:40:19Z 2026-04-23T11:40:19Z Shakya, Bigen Man Shrestha, Ninadini https://hdl.handle.net/20.500.14356/1600 2024-03-12T06:39:46Z 2018-01-01T00:00:00Z

Title: Continuous Fascia Iliaca Compartment Block for Post Operative Analgesia in Fracture Femur Authors: Shakya, Bigen Man; Shrestha, Ninadini Abstract: Abstract The postoperative pain management in the elderly is challenging due to comorbidities and change in physiology due to age itself. This limit the use of medication which include pain medication also. The fascia iliaca compartment block has been described in the literature for fracture of femur. It has even been safely used by non anaesthesiologist also. To our knowledge, we did not find any case report of continuous fascia iliaca compartment block published in Nepal. This is our first experience of successful continous fasicia iliaca compartment block in case of 89 year old lady with multiple co morbidities in whom traditional pain medication might be difficult to use. We encourage to practice this block which is both safe and easy to perform with good results. Keywords: Continous fascia iliaca compartment block. Description: Case Report

2018-01-01T00:00:00Z Acharya, Sudeep Joshi, Sandhya Chaulagain, Rajib https://hdl.handle.net/20.500.14356/1597 2024-03-12T06:40:17Z 2018-01-01T00:00:00Z

Title: Fibrodysplasia Ossificans Progressiva: A Case Report Authors: Acharya, Sudeep; Joshi, Sandhya; Chaulagain, Rajib Abstract: Abstract Fibrodysplasia ossificans progressiva is a genetic disorder of the connective tissue differentiation characterized by congenital malformation of the big toes and progressive heterotopic ossification in the extra skeletal tissues like tendons, ligaments, fascia and skeletal muscles leading to permanent disability. The prevalence is one in two million people. During childhood, it may be asymptomatic but in later life, progressive stiffness of major joints renders movement of the individual impossible. Currently, there is no effective treatment for this debilitating disease. Here, we present a case of 27 year old male with clinical and radiological features of fibrodysplasia ossificans progressiva. Keywords: Fibrodysplasia ossificans progressive; heterotopic ossification; myositis ossificans; myositis ossificans progressive. Description: Case Report

2018-01-01T00:00:00Z Bohara, Tanka Prasad Laudari, Uttam Parajuli, Anuj Rupakheti, Shail Joshi, Mukund Raj https://hdl.handle.net/20.500.14356/1595 2024-03-12T06:40:50Z 2018-01-01T00:00:00Z

Title: Prospective Validation of a Decision Tree Model for Prediction of Severity in Acute Pancreatitis Authors: Bohara, Tanka Prasad; Laudari, Uttam; Parajuli, Anuj; Rupakheti, Shail; Joshi, Mukund Raj Abstract: Abstract Background: Early identification of severe acute pancreatitis is important for early stratification, goal directed fluid therapy, rationalizing level of care to improve outcome. Various clinical, laboratory and imaging scoring system has been used to identify severe acute pancreatitis with variable results. Recently a decision tree model was proposed using serum creatinine, serum lactate dehydrogenase and oxygenation index to predict severe acute pancreatitis. This system is easy and usable at our centre. Hence, we conducted the study to validate the decision tree model prospectively. Methods: Patients admitted with a diagnosis of acute pancreatitis were included in the study. Decision tree model was used to identify patients at high and low risk for severe acute pancreatitis. Sensitivity and specificity were calculated for prediction of the decision tree model. Results: Fifty-three patients were included in the study. Fourty-one (77.4 %) patients with mild acute pancreatitis, five (9.4 %) patients had moderately severe pancreatitis and seven (13.2 %) patients had severe acute pancreatitis. Sensitivity and specificity of decision tree model to predict severity of pancreatitis was 97.83%(95 % CI – 88.47% to 99.94%) and 71.43 % % (95 % CI – 29.04% to 96.33%) respectively with positive and negative predictable value of 95.74 % % (95 % CI – 87.45% to 98.64%) and 83.33 % % (95 % CI – 40.49% to 97.35%) respectively. Conclusions: Decision tree model with serum creatinine, lactate dehydrogenase, and oxygenation index is an easy and useful tool to predict patients at high risk of developing severe acute pancreatitis. Keywords: Acute pancreatitis; decision tree; severe acute pancreatitis. Description: Original Article

2018-01-01T00:00:00Z Upadhyay, Amit Mani Kunwar, Ashok Shrestha, Sanjesh Pradhan, Hema Kumari Karki, Aruna Dangal https://hdl.handle.net/20.500.14356/1593 2024-03-12T06:41:32Z 2018-01-01T00:00:00Z

Title: Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries Authors: Upadhyay, Amit Mani; Kunwar, Ashok; Shrestha, Sanjesh; Pradhan, Hema Kumari; Karki, Aruna; Dangal Abstract: Abstract Background: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries. The aim of the study was to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in Kathmandu Model Hospital. Methods: This is a review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. We reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter, underwent Lich-Gregoir extravesical ureteroneocystostomy. In other five patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting could be done in only four patients. Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post-hysterectomy in 60% (n=9) followed by obstetrical procedures in 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury. Conclusions: Iatrogenic injury to the distal ureter during surgery was the leading cause for the ureterovaginal fistula. Endoscopic management with ureteric stents was still possible if the patients were referred earlier following primary surgery. Keywords: Double J stent; iatrogenic ureteric injury; ureterovaginal fistula; ureteroneocystostomy. Description: Original Article

2018-01-01T00:00:00Z