DOAJ (DOAJ: Directory of Open Access Journals), May 1, 2019
Background:. To compare the thunder-beat device with bipolar diathermy in surgical outcome of ton... more Background:. To compare the thunder-beat device with bipolar diathermy in surgical outcome of tonsillectomy. Methods: In this prospective study 75 patients who underwent tonsillectomy on one side using thunder beat device and on the other side using bipolar diathermy, were included. The intraoperative blood loss, operative time, post-operative pain and post-operative haemorrhage were taken for analysis in both the surgical procedures. Results: Among the seventy five patients, the age groups ranged from 19-36 years with mean age 25.36+/-5.54 years. Out of 75 patients, 21 were male and 54 were female.The comparison of operation time and intra-operative blood loss between thunder-beat and bipolar diathermy showed statistically significant differences. The comparison of pain score showed statistically significant result with better pain results in bipolar diathermy whereas the secondary haemorrhage was common in thunder beat device. Conclusion: The thunder-beat use in tonsillectomies is less time consuming with decreased intra-operative blood loss. But, the postoperative pain is more as compared to bipolar diathermy. Though, it is safe and effective in performing tonsillectomy but its cost is the main drawback for its regular use.
Zenodo (CERN European Organization for Nuclear Research), Jun 1, 2021
Background Deep neck infections are severe infections in potential spaces and fascial planes of t... more Background Deep neck infections are severe infections in potential spaces and fascial planes of the neck. Despite antibiotic therapy, these infections continue to cause significant morbidity and mortality. Objective To determine the clinical features, predisposing factors, socio demographic factors and complications associated with deep neck infections. Method Prospective study conducted in the Department of Otorhinolaryngology, Kathmandu University Dhulikhel Hospital between March 2018 and June 2020. Seventy-five patients with deep neck infections were enrolled. Result Submandibular abscess was most frequently observed (41.3%), followed by submental abscess (25.3%), parotid abscess(9.3%), ludwig's angina (6.7%), posterior triangle of neck abscess (4%), retropharyngeal abscess (2.7%), parapharyngeal space abscess (2.7%), and multiple space infections (8%). Staphylococcus aureus was the most common organism (53.3%), followed by Beta hemolytic Streptococcus (12%) and methicillin-resistant Staphylococcus aureus (12%). A negative culture was seen in 22.7%. Sixty-eight percent of patients underwent incision and drainage. Incision and drainage with dental extraction was done in 26.7%, four percent underwent incision and drainage with debridement and dental extraction, whereas 1.3% underwent incision and drainage with tracheostomy. Eight percent patients required Intensive care unit admission. Seven patients had descending mediastinitis, four out of which developed sepsis. When age and duration of hospital stay were correlated by using Pearson correlation coefficient, a remarkable correlation was observed (p=.020). Noteworthy relationship was not observed between different locations of deep neck infections and duration of hospital stay (p=.202). Conclusion Early identification of deep neck infections is often challenging. Proper knowledge and extreme vigilance is necessary when dealing with these complex entities to avoid life-threatening complications.
Background Hearing loss among neonates is one of the important health issue in pediatric populati... more Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15 th , 2017 to October 30 th , 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.
Background Head and neck cancer is a major public health problem worldwide. In spite of the incre... more Background Head and neck cancer is a major public health problem worldwide. In spite of the increase in incidence, there has been paucity of research on socio demographic factors influencing head and neck cancer. Objective To study the influence of various socio demographic factors on late presentation of head and neck cancer. Method Prospective, analytical study conducted in 69 patients with Head and neck malignancies in Department of Otorhinolaryngology and Head and Neck surgery, Kathmandu University School of Medical sciences between January 2015 to January 2016. Collected data were entered and analyzed using IBM SPSS statistical software 21.0. All the socio demographic variables were compared between the early and late presentation groups of patient using Chi-square test. A 'p' value of < 0.05 was considered statistically significant. Result Forty eight were male and 21 were female. The age of patients ranged from 34 to 70 years (mean age 52.03). Twenty patients were diagnosed in stage I, 13 in stage II, 20 in stage III and 16 in stage IV. Significant association was seen between stage of head and neck cancer and duration of illness (p=0.007), educational status of patient (p=0.003) and educational status of patient's care taker (p=0.005). However, no statistical association was seen between stage at diagnosis of head and neck cancer and gender, type of family, previous consultation, systems of alternative medicine adopted before diagnosis, smoking habit, alcohol intake, tobacco chewing habit and occupation. Conclusion The results of this study suggest that educational status may influence the presentation of head and neck cancer.
Background ENT (Ear, Nose and Throat) surgeons are particularly at high risk of exposure with blo... more Background ENT (Ear, Nose and Throat) surgeons are particularly at high risk of exposure with blood and body fluid related infections both in Outpatient and during surgical procedures. They do take precaution to avoid the needle stick injuries but few pay attention on blood or body fluid splashes into eye. Objective To find out the risk of blood splashes to both surgeon and assistant during otorhinolaryngology surgeries. Method This was an descriptive study and data were collected prospectively in Department of Ear, Nose and Throat-Head and Neck Surgery of Dhulikhel Hospital, Kathmandu University Hospital in 1 year period from 1st January 2017 to 1st January 2018. All the surgical cases were included in the study. The surgeon and assistant wore the glass and mask during the surgery. At the end of the surgery, the glass, mask and gown were inspected for any blood splashes and information was recorded. Result There were total 272 patients with male 119 and female 153. The amount of blood splatter in glass, mask and gown is most common in modified radical mastoidectomy surgery. Likewise, the blood splatter is most common in tonsillectomy in throat surgery and in head and neck surgery, the blood splatter is common in all head and neck surgery. Conclusion The blood splashes is high in various Ear, Nose and Throat surgeries. So it is important to take precaution by surgeon and assistant, like protective mask and glass worn during surgeries to protect from various blood-borne infection transmissions.
International Journal of Scientific Reports, Apr 1, 2017
We conducted this study in patients who underwent endoscopic cartilage myringoplasty with COM muc... more We conducted this study in patients who underwent endoscopic cartilage myringoplasty with COM mucosal type disease and we had evaluated the health related quality of life (HRQOL) pre and post-operatively using COMOT-15 questionnaire.
Kathmandu University Medical Journal, Sep 30, 2022
Background There are different methods to repair the perforation of the tympanic membrane. Recent... more Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing.
Kathmandu University Medical Journal, Sep 30, 2021
Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that... more Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that poses a significant burden on the healthcare system. Objective To determine the role of predictors for Obstructive sleep apnea syndrome and its severity in Nepalese population. Method Prospective and analytical study conducted in the Department of Otorhinolaryngology and Head and Neck surgery at Kathmandu University Hospital between March 2018 and June 2020. A total of 85 adult patients with Obstructive sleep apnea with an Epworth sleepiness score greater than 10 were included. Overnight polysomnography was done and scoring of sleep associated events were done according to the American Academy of Sleep Medicine criteria. Participants were classified as simple snoring and mild, moderate or severe Obstructive sleep apnea syndrome groups depending on the Apnea Hypopnea Index values. Relationship of Apnea hypopnea index was analyzed with age, neck circumference, body mass index and Epworth Sleepiness score. Result Simple snoring was seen in 18(21.17%) patients, 14(16.47%) had mild Obstructive sleep apnea, 13(15.29%) had moderate Obstructive sleep apnea, whereas the severe group consisted of 40(47.05%) patients. The minimum Epworth Sleepiness Score was 10 and the maximum was 25. The Apnea hypopnea index correlated positively with Body mass index (p=.010) and Epworth sleepiness score (p<.001). However, Apnea hypopnea index had no association with age (p=.437) and neck circumference (p=.118). Conclusion Health professionals need to be extremely vigilant while examining patients presenting with Obstructive Sleep Apnea. Polysomnography is the investigation of choice in the early identification of this treatable disease.
Introduction Acute mastoiditis (AM) is a common intra-temporal complication of acute otitis media... more Introduction Acute mastoiditis (AM) is a common intra-temporal complication of acute otitis media (AOM) and is more commonly seen in children. Occasionally, it presents as the first sign of ear disease. This study aimed to evaluate the clinical course of AM and determine therapeutic options for pediatric patients presenting with AM. Methods This was a prospective, observational study conducted on patients with AM presenting at a tertiary center during one year period. Convenience sampling was employed and 79 pediatric patients (18 years or below) were recruited for the study. Data on the demographic profile of patients, the treatment offered, duration of hospital stay, and outcome were analyzed. Result In our study, 62% were male patients (n = 49) and 38% (n = 30) were females. The mean age of patients was 9.32 ± 5.3 years and a history of AOM was present in 60 (75.9%). On admission, the most common presentation was post-auricular inflammation (100%) followed by otalgia (79.7%), fever (59.5%), aural protrusion (54.4%), and otorrhoea (51.9%). Culture reports were available for 54 (68.4%) patients and 30 (38%) grew organisms. The cultured organisms were Streptococcus pneumonia (20.3%), Pseudomonas aeruginosa (10.1%), Streptococcus pyogenes (3.8%), and Staphylococcus aureus (3.8%). Most patients were managed conservatively (n = 66, 83.5%) whereas surgery was performed in 16.5% (n = 13) patients. The mean hospital stay was 5.58 ± 1.99 days. The need for surgical management was significantly associated with age >5 years (p = 0.006), history of AOM (p = 0.026) and the presence of complications (p = 0.012). Subperiosteal abscess (SA) was present in 21 (26.6%) patients and one had facial palsy. SA along with AM had a mean hospital stay of 8.5 ± 0.77 days compared to 4.94 ± 1.43 days in case of isolated AM (p < 0.001) and the mean age of presentation in SA with AM was 11.97 ± 5.13 years compared to 8.29 ± 5.14 years in case of isolated AM (p = 0.006). All patients recovered and were followed up to three months with no recurrence, complications, or sequelae. Conclusion Most of the cases of acute mastoiditis follow previous AOM episodes. With early recognition and effective treatment, the prognosis is good.
Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobe... more Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobes are joined by an isthmus and this resemble the letter "H". A wide range of morphological variations and developmental anomalies of the thyroid gland like hypoplasia, ectopy, hemiagenesis, and agenesis have been reported in literature. Out of these, the incidence of agenesis of the thyroid isthmus is rare, and very few cases have been reported. In our report, 28 year old male patient was found with agenesis of thyroid isthmus with papillary carcinoma in the right lobe of thyroid. During the operation it was seen that the right and left thyroid lobes were independent from each other and isthmus was absent. We will present a case of thyroid isthmus agenesis and discuss the clinical importance and the incidence of this case.
with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. ... more with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. There is no history of difficulty swallowing or recurrent throat infection. Physical examination revealed a pedunculated mass arising from upper pole of left tonsil. Bilateral tonsillectomy was done under general anaesthesia. Grossly, 2.5 × 1.5 × 1 cm polypoidal mass, soft in consistency, was found to be attached to left tonsil. Histopathology report was consistent with lymphangiomatous polyp of tonsil. Postoperative period was uneventful and she was normal during her follow-up at 1 month with bilateral healthy tonsillar fossa.
Kathmandu University Medical Journal, Oct 20, 2015
Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14%... more Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14% of the general population each year. Although its lifetime incidence is about 60%, only 6% require formal medical intervention but they can be serious and even life threatening. Objective The main objectives are to study different etiology, types, modality of treatment of epistaxis. Specific objective is also to find out if the modality of treatment is associated with age, site, amount of bleeding and etiology. Method It is a prospective, cross sectional, longitudinal, analytical study done in Department of ENT, Dhulikhel hospital, Kathmandu University School of Medical Sciences (KUSMS) from Aug. 2010 to Aug. 2013. Data was collected. This study was cleared through institutional review committee of hospital. Statistical analysis was done using SPSS 16.0. Result 487 patients were studied during the period. There was significant association between age group with type of treatment (p value 0.002); and with admission (p value < 0.001). Significance in the study was also shown in the correlation between site of bleeding and the type of treatment and also with alcohol intake with site of bleeding (p value < 0.001).However there was no significance between hypertension and the type of treatment methods chosen (p value >0.01). Conclusion Management of epistaxis is challenging. Most are managed by non surgical means whereas some by surgical treatment. Non surgical treatment is still useful, safe and cost effective. Type of treatment and need for hospital stay is related to age and site of bleeding.
Kathmandu University Medical Journal, Jun 30, 2021
Background Thyroid cancer is associated with local and systemic inflammatory activities. Many sys... more Background Thyroid cancer is associated with local and systemic inflammatory activities. Many systemic inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had shown credible and independent prognostic biomarkers in different malignant conditions. These markers are easy to reproduce, measure and inexpensive also. So, the preoperative evaluation of NLR and PLR is helpful in evaluating tumor growth and prognosis of papillary carcinoma of thyroid. Objective To evaluate the association of pre-operative NLR and PLR with clinic-pathological characteristic in papillary carcinoma of thyroid. Method This was a retrospective study performed in thirty one patients with the diagnosis of papillary carcinoma of thyroid. Preoperative NLR and PLR values were correlated with the clinical parameters like age, gender, lymph node metastasis, tumor size and pathological features (e.g., multifocality, bilaterality, extrathyroidal spread). Result There were thirty one patients, amongst which 13 were male and 18 were female. Similarly, the age distribution ranges from 27-68 years. The value of NLR was 2.37±1.09, and the value of PLR was 96.69±49.53.The increase in NLR was associated with increase in tumor size with statistically significant results. Similarly, increase in PLR was associated with increase in tumor size and multifocality with statistically significant results. Conclusion Increase NLR and PLR is associated with lymph node metastasis, extra thyroidal extension, multifocality of tumor and also bilaterality, so the risk can be stratified beforehand with measurement of NLR and PLR.
Rhabdomyosarcoma comprises about half of the soft tissue tumors. Approximately 40% of the alveola... more Rhabdomyosarcoma comprises about half of the soft tissue tumors. Approximately 40% of the alveolar subtype occur in the head and neck region. Patients present with unilateral nasal mass with/without lymphadenopathy and with/without orbital manifestations. Diagnosis is aided radiologically by CT scan, MRI along with biopsy and is confirmed by immunohistochemistry. Treatment involves surgical resection, chemotherapy, radiotherapy or a combination of these. In spite of treatments, however, the outcome is poor. This is a case report of 14-year-old male who presented with unilateral nasal mass with proptosis of right eye who was eventually diagnosed as a case of alveolar rhabdomyosarcoma of solid variant.
Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. ... more Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of sandwich cartilage perichondrium in the repair of tympanic membrane peroration has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long-term hearing results in patients who underwent endoscopic sandwich myringoplasty with Dhulikhel Hospital (D-HOS) technique. Materials and Methodology: This was a prospective, cohort study performed among 45 patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage and perichondrium. The hearing was assessed by comparing pre- with post-operative air-bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). Results: Among forty-five patients, 42 (93.3%) had graft uptake in 12 months of follow-up. The postoperative ABG (17.0 ± 8.5 dB) was lesser than preoperative ABG (27.3 ± 12.5 dB) with statistically significant results. Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a safe procedure with high-graft uptake rate and good long-term hearing results.
Kathmandu University Medical Journal, Feb 26, 2017
Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis an... more Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p=<0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended.
Kathmandu University Medical Journal, Feb 25, 2017
Background Surgery on a deviated septum has seen several modifications since its inception starti... more Background Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. Objective To compare the efficacies of "Endoscope Septoplasty" over "Traditional Septoplasty" in treating pathological septum and turbinates, in terms of their outcome. Method Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z-test. Result The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25 %. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01) Conclusion Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery.
Human papillomavirus (HPV) is a common sexually transmitted disease worldwide. While burden of HP... more Human papillomavirus (HPV) is a common sexually transmitted disease worldwide. While burden of HPV-associated cancers and mortality is higher in low-income countries, there is limited data about knowledge of it among health care students and professionals. We assessed awareness and knowledge of HPV, its related diseases, and HPV vaccine among 333 participants, composed of 146 medical students (MSs) and professionals (MPs) and 187 nursing students (NSs) and professionals (NPs) using a 40-question survey between July 2018 and February 2019. Surveys were conducted in English language using both paper and an online version. Most participants reported that they had heard of HPV and cervical cancer. However, 91.76% of MPs and 77.97% of MSs, but only 41.11% of NPs and 36.17% NSs reported knowing that HPV types 16 and 18 caused cervical cancer. Likewise, about two-thirds of MPs and MSs reported having the knowledge that HPV 6 and 11 caused genital warts versus only a little over one-fourth of NPs and NSs. Only 55.91% of NPs and 51.61% of NSs were aware that HPV could cause cancer in both men and women, whereas 42.35% of MPs, 64.41% of MSs, 41.76% of NPs, and 40.66% of NSs were aware that the vaccine could be given to both boys and girls. While medical professionals were relatively more knowledgeable about HPV and related diseases, overall, knowledge about the HPV vaccine was low among all groups. This knowledge gap is concerning and warrants further attention to fight HPV-related public health burden in Nepal.
Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngologic... more Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngological practice, its diagnosis is not very easy because of its indistinct symptoms Objective To assess the efficacy of proton pump inhibitors versus proton pump inhibitors with lifestyle modification in patients with laryngopharyngeal reflux. Method Prospective, analytical study conducted in Department of Otorhinolaryngology and Head and Neck Surgery at Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Eighty two patients with laryngopharyngeal reflux having Reflux symptom index > 13 and Reflux finding score > 7 were included. Patients were divided into 2 groups. Group A comprised of patients treated with proton pump inhibitors alone and Group B with Proton pump inhibitors with lifestyle modification. Pre and post therapeutic reflux finding score and reflux symptom index were compared. Result The mean reflux symptom index score difference before and after treatment in group A was 16.70 and group B was 14.58. Similarly, mean reflux finding score difference before and after treatment in group A was 8.68 and group B was 9.92. Comparison of reflux finding score and reflux symptom index scores before and after treatment revealed improvement in both groups and the difference was statistically significant (p<0.001). However, comparison of pre and post therapeutic and scores between group A and B, showed no statistical significance. Conclusion The extent of symptomatic improvement correlated positively with both proton pump inhibitor therapy alone as well as with proton pump inhibitor therapy along with lifestyle modification. Although addition of lifestyle modification offered incremental benefit for treating laryngopharyngeal reflux, it was not found to be statistically significant.
Background Oral cancer is a major public health problem worldwide. It has high mortality rates an... more Background Oral cancer is a major public health problem worldwide. It has high mortality rates and chances of survival is relatively superior when detected early. Lack of knowledge and awareness about oral cancer among medical students may contribute to delay in diagnosis and treatment. Objective To assess awareness and knowledge of oral cancer among medical students. Method A cross-sectional study conducted among 286 students by Department of Otorhinolaryngology and Head & Neck surgery, Kathmandu University School of Medical sciences between July to August 2016. A questionnaire with questions on socio-demographic profile, awareness and knowledge of oral cancer was used. Independent sample t test and Pearson Chi-square tests were used for statistical analysis. Result Out of 329 students approached, 286 participated in the study yielding a response rate of 86.9%. Symptoms of oral cancer as reported were ulceration in mouth (92.3%), oral bleeding (85.0%),whitish or reddish patch (84.3%), halitosis (75.5%) and swelling in neck (74.5%), trismus (69.2%), numbness (67.1%), loosening of teeth (49.3%) and tooth sensitivity (41.6%). The perceived risk factors were smoking (97.2%), tobacco chewing (96.5%), chronic irritation (86.7%), immunodeficiency (83.9%), poor oral hygiene (88.5%), human papilloma virus infection (82.5%), dietary factors (81.1%), alcohol (79.4%), ill-fitting dentures (72.4%), hot spicy food (65.4%) and hot beverages (58.0%). Significant differences were found between pre-clinical and clinical students for knowledge of risk factors, signs and symptoms of oral cancer (p<0.001). Conclusion There is deficiency of knowledge among medical students about some aspects of oral cancer. Active involvement while examining patients and taking biopsies of malignant and premalignant lesions may help in improving students' knowledge about oral cancer.
DOAJ (DOAJ: Directory of Open Access Journals), May 1, 2019
Background:. To compare the thunder-beat device with bipolar diathermy in surgical outcome of ton... more Background:. To compare the thunder-beat device with bipolar diathermy in surgical outcome of tonsillectomy. Methods: In this prospective study 75 patients who underwent tonsillectomy on one side using thunder beat device and on the other side using bipolar diathermy, were included. The intraoperative blood loss, operative time, post-operative pain and post-operative haemorrhage were taken for analysis in both the surgical procedures. Results: Among the seventy five patients, the age groups ranged from 19-36 years with mean age 25.36+/-5.54 years. Out of 75 patients, 21 were male and 54 were female.The comparison of operation time and intra-operative blood loss between thunder-beat and bipolar diathermy showed statistically significant differences. The comparison of pain score showed statistically significant result with better pain results in bipolar diathermy whereas the secondary haemorrhage was common in thunder beat device. Conclusion: The thunder-beat use in tonsillectomies is less time consuming with decreased intra-operative blood loss. But, the postoperative pain is more as compared to bipolar diathermy. Though, it is safe and effective in performing tonsillectomy but its cost is the main drawback for its regular use.
Zenodo (CERN European Organization for Nuclear Research), Jun 1, 2021
Background Deep neck infections are severe infections in potential spaces and fascial planes of t... more Background Deep neck infections are severe infections in potential spaces and fascial planes of the neck. Despite antibiotic therapy, these infections continue to cause significant morbidity and mortality. Objective To determine the clinical features, predisposing factors, socio demographic factors and complications associated with deep neck infections. Method Prospective study conducted in the Department of Otorhinolaryngology, Kathmandu University Dhulikhel Hospital between March 2018 and June 2020. Seventy-five patients with deep neck infections were enrolled. Result Submandibular abscess was most frequently observed (41.3%), followed by submental abscess (25.3%), parotid abscess(9.3%), ludwig's angina (6.7%), posterior triangle of neck abscess (4%), retropharyngeal abscess (2.7%), parapharyngeal space abscess (2.7%), and multiple space infections (8%). Staphylococcus aureus was the most common organism (53.3%), followed by Beta hemolytic Streptococcus (12%) and methicillin-resistant Staphylococcus aureus (12%). A negative culture was seen in 22.7%. Sixty-eight percent of patients underwent incision and drainage. Incision and drainage with dental extraction was done in 26.7%, four percent underwent incision and drainage with debridement and dental extraction, whereas 1.3% underwent incision and drainage with tracheostomy. Eight percent patients required Intensive care unit admission. Seven patients had descending mediastinitis, four out of which developed sepsis. When age and duration of hospital stay were correlated by using Pearson correlation coefficient, a remarkable correlation was observed (p=.020). Noteworthy relationship was not observed between different locations of deep neck infections and duration of hospital stay (p=.202). Conclusion Early identification of deep neck infections is often challenging. Proper knowledge and extreme vigilance is necessary when dealing with these complex entities to avoid life-threatening complications.
Background Hearing loss among neonates is one of the important health issue in pediatric populati... more Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15 th , 2017 to October 30 th , 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.
Background Head and neck cancer is a major public health problem worldwide. In spite of the incre... more Background Head and neck cancer is a major public health problem worldwide. In spite of the increase in incidence, there has been paucity of research on socio demographic factors influencing head and neck cancer. Objective To study the influence of various socio demographic factors on late presentation of head and neck cancer. Method Prospective, analytical study conducted in 69 patients with Head and neck malignancies in Department of Otorhinolaryngology and Head and Neck surgery, Kathmandu University School of Medical sciences between January 2015 to January 2016. Collected data were entered and analyzed using IBM SPSS statistical software 21.0. All the socio demographic variables were compared between the early and late presentation groups of patient using Chi-square test. A 'p' value of < 0.05 was considered statistically significant. Result Forty eight were male and 21 were female. The age of patients ranged from 34 to 70 years (mean age 52.03). Twenty patients were diagnosed in stage I, 13 in stage II, 20 in stage III and 16 in stage IV. Significant association was seen between stage of head and neck cancer and duration of illness (p=0.007), educational status of patient (p=0.003) and educational status of patient's care taker (p=0.005). However, no statistical association was seen between stage at diagnosis of head and neck cancer and gender, type of family, previous consultation, systems of alternative medicine adopted before diagnosis, smoking habit, alcohol intake, tobacco chewing habit and occupation. Conclusion The results of this study suggest that educational status may influence the presentation of head and neck cancer.
Background ENT (Ear, Nose and Throat) surgeons are particularly at high risk of exposure with blo... more Background ENT (Ear, Nose and Throat) surgeons are particularly at high risk of exposure with blood and body fluid related infections both in Outpatient and during surgical procedures. They do take precaution to avoid the needle stick injuries but few pay attention on blood or body fluid splashes into eye. Objective To find out the risk of blood splashes to both surgeon and assistant during otorhinolaryngology surgeries. Method This was an descriptive study and data were collected prospectively in Department of Ear, Nose and Throat-Head and Neck Surgery of Dhulikhel Hospital, Kathmandu University Hospital in 1 year period from 1st January 2017 to 1st January 2018. All the surgical cases were included in the study. The surgeon and assistant wore the glass and mask during the surgery. At the end of the surgery, the glass, mask and gown were inspected for any blood splashes and information was recorded. Result There were total 272 patients with male 119 and female 153. The amount of blood splatter in glass, mask and gown is most common in modified radical mastoidectomy surgery. Likewise, the blood splatter is most common in tonsillectomy in throat surgery and in head and neck surgery, the blood splatter is common in all head and neck surgery. Conclusion The blood splashes is high in various Ear, Nose and Throat surgeries. So it is important to take precaution by surgeon and assistant, like protective mask and glass worn during surgeries to protect from various blood-borne infection transmissions.
International Journal of Scientific Reports, Apr 1, 2017
We conducted this study in patients who underwent endoscopic cartilage myringoplasty with COM muc... more We conducted this study in patients who underwent endoscopic cartilage myringoplasty with COM mucosal type disease and we had evaluated the health related quality of life (HRQOL) pre and post-operatively using COMOT-15 questionnaire.
Kathmandu University Medical Journal, Sep 30, 2022
Background There are different methods to repair the perforation of the tympanic membrane. Recent... more Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing.
Kathmandu University Medical Journal, Sep 30, 2021
Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that... more Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that poses a significant burden on the healthcare system. Objective To determine the role of predictors for Obstructive sleep apnea syndrome and its severity in Nepalese population. Method Prospective and analytical study conducted in the Department of Otorhinolaryngology and Head and Neck surgery at Kathmandu University Hospital between March 2018 and June 2020. A total of 85 adult patients with Obstructive sleep apnea with an Epworth sleepiness score greater than 10 were included. Overnight polysomnography was done and scoring of sleep associated events were done according to the American Academy of Sleep Medicine criteria. Participants were classified as simple snoring and mild, moderate or severe Obstructive sleep apnea syndrome groups depending on the Apnea Hypopnea Index values. Relationship of Apnea hypopnea index was analyzed with age, neck circumference, body mass index and Epworth Sleepiness score. Result Simple snoring was seen in 18(21.17%) patients, 14(16.47%) had mild Obstructive sleep apnea, 13(15.29%) had moderate Obstructive sleep apnea, whereas the severe group consisted of 40(47.05%) patients. The minimum Epworth Sleepiness Score was 10 and the maximum was 25. The Apnea hypopnea index correlated positively with Body mass index (p=.010) and Epworth sleepiness score (p<.001). However, Apnea hypopnea index had no association with age (p=.437) and neck circumference (p=.118). Conclusion Health professionals need to be extremely vigilant while examining patients presenting with Obstructive Sleep Apnea. Polysomnography is the investigation of choice in the early identification of this treatable disease.
Introduction Acute mastoiditis (AM) is a common intra-temporal complication of acute otitis media... more Introduction Acute mastoiditis (AM) is a common intra-temporal complication of acute otitis media (AOM) and is more commonly seen in children. Occasionally, it presents as the first sign of ear disease. This study aimed to evaluate the clinical course of AM and determine therapeutic options for pediatric patients presenting with AM. Methods This was a prospective, observational study conducted on patients with AM presenting at a tertiary center during one year period. Convenience sampling was employed and 79 pediatric patients (18 years or below) were recruited for the study. Data on the demographic profile of patients, the treatment offered, duration of hospital stay, and outcome were analyzed. Result In our study, 62% were male patients (n = 49) and 38% (n = 30) were females. The mean age of patients was 9.32 ± 5.3 years and a history of AOM was present in 60 (75.9%). On admission, the most common presentation was post-auricular inflammation (100%) followed by otalgia (79.7%), fever (59.5%), aural protrusion (54.4%), and otorrhoea (51.9%). Culture reports were available for 54 (68.4%) patients and 30 (38%) grew organisms. The cultured organisms were Streptococcus pneumonia (20.3%), Pseudomonas aeruginosa (10.1%), Streptococcus pyogenes (3.8%), and Staphylococcus aureus (3.8%). Most patients were managed conservatively (n = 66, 83.5%) whereas surgery was performed in 16.5% (n = 13) patients. The mean hospital stay was 5.58 ± 1.99 days. The need for surgical management was significantly associated with age >5 years (p = 0.006), history of AOM (p = 0.026) and the presence of complications (p = 0.012). Subperiosteal abscess (SA) was present in 21 (26.6%) patients and one had facial palsy. SA along with AM had a mean hospital stay of 8.5 ± 0.77 days compared to 4.94 ± 1.43 days in case of isolated AM (p < 0.001) and the mean age of presentation in SA with AM was 11.97 ± 5.13 years compared to 8.29 ± 5.14 years in case of isolated AM (p = 0.006). All patients recovered and were followed up to three months with no recurrence, complications, or sequelae. Conclusion Most of the cases of acute mastoiditis follow previous AOM episodes. With early recognition and effective treatment, the prognosis is good.
Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobe... more Thyroid gland is the largest of all endocrine glands. It is composed of two lobes. These two lobes are joined by an isthmus and this resemble the letter "H". A wide range of morphological variations and developmental anomalies of the thyroid gland like hypoplasia, ectopy, hemiagenesis, and agenesis have been reported in literature. Out of these, the incidence of agenesis of the thyroid isthmus is rare, and very few cases have been reported. In our report, 28 year old male patient was found with agenesis of thyroid isthmus with papillary carcinoma in the right lobe of thyroid. During the operation it was seen that the right and left thyroid lobes were independent from each other and isthmus was absent. We will present a case of thyroid isthmus agenesis and discuss the clinical importance and the incidence of this case.
with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. ... more with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. There is no history of difficulty swallowing or recurrent throat infection. Physical examination revealed a pedunculated mass arising from upper pole of left tonsil. Bilateral tonsillectomy was done under general anaesthesia. Grossly, 2.5 × 1.5 × 1 cm polypoidal mass, soft in consistency, was found to be attached to left tonsil. Histopathology report was consistent with lymphangiomatous polyp of tonsil. Postoperative period was uneventful and she was normal during her follow-up at 1 month with bilateral healthy tonsillar fossa.
Kathmandu University Medical Journal, Oct 20, 2015
Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14%... more Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14% of the general population each year. Although its lifetime incidence is about 60%, only 6% require formal medical intervention but they can be serious and even life threatening. Objective The main objectives are to study different etiology, types, modality of treatment of epistaxis. Specific objective is also to find out if the modality of treatment is associated with age, site, amount of bleeding and etiology. Method It is a prospective, cross sectional, longitudinal, analytical study done in Department of ENT, Dhulikhel hospital, Kathmandu University School of Medical Sciences (KUSMS) from Aug. 2010 to Aug. 2013. Data was collected. This study was cleared through institutional review committee of hospital. Statistical analysis was done using SPSS 16.0. Result 487 patients were studied during the period. There was significant association between age group with type of treatment (p value 0.002); and with admission (p value < 0.001). Significance in the study was also shown in the correlation between site of bleeding and the type of treatment and also with alcohol intake with site of bleeding (p value < 0.001).However there was no significance between hypertension and the type of treatment methods chosen (p value >0.01). Conclusion Management of epistaxis is challenging. Most are managed by non surgical means whereas some by surgical treatment. Non surgical treatment is still useful, safe and cost effective. Type of treatment and need for hospital stay is related to age and site of bleeding.
Kathmandu University Medical Journal, Jun 30, 2021
Background Thyroid cancer is associated with local and systemic inflammatory activities. Many sys... more Background Thyroid cancer is associated with local and systemic inflammatory activities. Many systemic inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had shown credible and independent prognostic biomarkers in different malignant conditions. These markers are easy to reproduce, measure and inexpensive also. So, the preoperative evaluation of NLR and PLR is helpful in evaluating tumor growth and prognosis of papillary carcinoma of thyroid. Objective To evaluate the association of pre-operative NLR and PLR with clinic-pathological characteristic in papillary carcinoma of thyroid. Method This was a retrospective study performed in thirty one patients with the diagnosis of papillary carcinoma of thyroid. Preoperative NLR and PLR values were correlated with the clinical parameters like age, gender, lymph node metastasis, tumor size and pathological features (e.g., multifocality, bilaterality, extrathyroidal spread). Result There were thirty one patients, amongst which 13 were male and 18 were female. Similarly, the age distribution ranges from 27-68 years. The value of NLR was 2.37±1.09, and the value of PLR was 96.69±49.53.The increase in NLR was associated with increase in tumor size with statistically significant results. Similarly, increase in PLR was associated with increase in tumor size and multifocality with statistically significant results. Conclusion Increase NLR and PLR is associated with lymph node metastasis, extra thyroidal extension, multifocality of tumor and also bilaterality, so the risk can be stratified beforehand with measurement of NLR and PLR.
Rhabdomyosarcoma comprises about half of the soft tissue tumors. Approximately 40% of the alveola... more Rhabdomyosarcoma comprises about half of the soft tissue tumors. Approximately 40% of the alveolar subtype occur in the head and neck region. Patients present with unilateral nasal mass with/without lymphadenopathy and with/without orbital manifestations. Diagnosis is aided radiologically by CT scan, MRI along with biopsy and is confirmed by immunohistochemistry. Treatment involves surgical resection, chemotherapy, radiotherapy or a combination of these. In spite of treatments, however, the outcome is poor. This is a case report of 14-year-old male who presented with unilateral nasal mass with proptosis of right eye who was eventually diagnosed as a case of alveolar rhabdomyosarcoma of solid variant.
Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. ... more Background: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of sandwich cartilage perichondrium in the repair of tympanic membrane peroration has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long-term hearing results in patients who underwent endoscopic sandwich myringoplasty with Dhulikhel Hospital (D-HOS) technique. Materials and Methodology: This was a prospective, cohort study performed among 45 patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage and perichondrium. The hearing was assessed by comparing pre- with post-operative air-bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). Results: Among forty-five patients, 42 (93.3%) had graft uptake in 12 months of follow-up. The postoperative ABG (17.0 ± 8.5 dB) was lesser than preoperative ABG (27.3 ± 12.5 dB) with statistically significant results. Conclusion: Endoscopic sandwich myringoplasty with D-HOS technique is a safe procedure with high-graft uptake rate and good long-term hearing results.
Kathmandu University Medical Journal, Feb 26, 2017
Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis an... more Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p=<0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended.
Kathmandu University Medical Journal, Feb 25, 2017
Background Surgery on a deviated septum has seen several modifications since its inception starti... more Background Surgery on a deviated septum has seen several modifications since its inception starting from radical septal resection to preservation of the possible septal framework. Objective To compare the efficacies of "Endoscope Septoplasty" over "Traditional Septoplasty" in treating pathological septum and turbinates, in terms of their outcome. Method Prospective descriptive study conducted on 60 patients who presented to the Department of ENT, Kathmandu University School of Medical sciences during a period of two years. The severity of the symptoms of the patients was scored using a visual analogue scale which was compared post operatively to subjectively evaluate the efficacy of either surgery. Objective assessment was done by nasal endoscopy. P value in case of subjective and objective evaluation was done by applying Z-test. Result The mean age ± SD was 29.5±1.2 .Maximum patients fell into age group of 21-30 with 31.7 % followed by 11-20 with 28.3% and then 31-40 with 25 %. There were total 35 males (58.3%) and 25 females (41.7%). Among the symptoms, nasal obstruction seems to be dominating with total of 83.3%, followed by postnasal drip with 66.6% and then headache with 60%. The types of dislocation was compared, there were 66.7% cases with DNS and Spur whereas only 10 % with isolated spur. C shaped deformity was seen in 30% and S shaped in 26.6 % cases. Significance in Z test, is seen in subjective assessment post surgery for nasal obstruction, headache and rhinorrhea and for objective assessment post surgery for persistent contact with turbinates. (p value set to 0.01) Conclusion Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative alternative to conventional septal surgery.
Human papillomavirus (HPV) is a common sexually transmitted disease worldwide. While burden of HP... more Human papillomavirus (HPV) is a common sexually transmitted disease worldwide. While burden of HPV-associated cancers and mortality is higher in low-income countries, there is limited data about knowledge of it among health care students and professionals. We assessed awareness and knowledge of HPV, its related diseases, and HPV vaccine among 333 participants, composed of 146 medical students (MSs) and professionals (MPs) and 187 nursing students (NSs) and professionals (NPs) using a 40-question survey between July 2018 and February 2019. Surveys were conducted in English language using both paper and an online version. Most participants reported that they had heard of HPV and cervical cancer. However, 91.76% of MPs and 77.97% of MSs, but only 41.11% of NPs and 36.17% NSs reported knowing that HPV types 16 and 18 caused cervical cancer. Likewise, about two-thirds of MPs and MSs reported having the knowledge that HPV 6 and 11 caused genital warts versus only a little over one-fourth of NPs and NSs. Only 55.91% of NPs and 51.61% of NSs were aware that HPV could cause cancer in both men and women, whereas 42.35% of MPs, 64.41% of MSs, 41.76% of NPs, and 40.66% of NSs were aware that the vaccine could be given to both boys and girls. While medical professionals were relatively more knowledgeable about HPV and related diseases, overall, knowledge about the HPV vaccine was low among all groups. This knowledge gap is concerning and warrants further attention to fight HPV-related public health burden in Nepal.
Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngologic... more Background Although laryngopharyngeal reflux is a common condition encountered in otolaryngological practice, its diagnosis is not very easy because of its indistinct symptoms Objective To assess the efficacy of proton pump inhibitors versus proton pump inhibitors with lifestyle modification in patients with laryngopharyngeal reflux. Method Prospective, analytical study conducted in Department of Otorhinolaryngology and Head and Neck Surgery at Dhulikhel Hospital, Kathmandu University Hospital between January 2015 to January 2016. Eighty two patients with laryngopharyngeal reflux having Reflux symptom index > 13 and Reflux finding score > 7 were included. Patients were divided into 2 groups. Group A comprised of patients treated with proton pump inhibitors alone and Group B with Proton pump inhibitors with lifestyle modification. Pre and post therapeutic reflux finding score and reflux symptom index were compared. Result The mean reflux symptom index score difference before and after treatment in group A was 16.70 and group B was 14.58. Similarly, mean reflux finding score difference before and after treatment in group A was 8.68 and group B was 9.92. Comparison of reflux finding score and reflux symptom index scores before and after treatment revealed improvement in both groups and the difference was statistically significant (p<0.001). However, comparison of pre and post therapeutic and scores between group A and B, showed no statistical significance. Conclusion The extent of symptomatic improvement correlated positively with both proton pump inhibitor therapy alone as well as with proton pump inhibitor therapy along with lifestyle modification. Although addition of lifestyle modification offered incremental benefit for treating laryngopharyngeal reflux, it was not found to be statistically significant.
Background Oral cancer is a major public health problem worldwide. It has high mortality rates an... more Background Oral cancer is a major public health problem worldwide. It has high mortality rates and chances of survival is relatively superior when detected early. Lack of knowledge and awareness about oral cancer among medical students may contribute to delay in diagnosis and treatment. Objective To assess awareness and knowledge of oral cancer among medical students. Method A cross-sectional study conducted among 286 students by Department of Otorhinolaryngology and Head & Neck surgery, Kathmandu University School of Medical sciences between July to August 2016. A questionnaire with questions on socio-demographic profile, awareness and knowledge of oral cancer was used. Independent sample t test and Pearson Chi-square tests were used for statistical analysis. Result Out of 329 students approached, 286 participated in the study yielding a response rate of 86.9%. Symptoms of oral cancer as reported were ulceration in mouth (92.3%), oral bleeding (85.0%),whitish or reddish patch (84.3%), halitosis (75.5%) and swelling in neck (74.5%), trismus (69.2%), numbness (67.1%), loosening of teeth (49.3%) and tooth sensitivity (41.6%). The perceived risk factors were smoking (97.2%), tobacco chewing (96.5%), chronic irritation (86.7%), immunodeficiency (83.9%), poor oral hygiene (88.5%), human papilloma virus infection (82.5%), dietary factors (81.1%), alcohol (79.4%), ill-fitting dentures (72.4%), hot spicy food (65.4%) and hot beverages (58.0%). Significant differences were found between pre-clinical and clinical students for knowledge of risk factors, signs and symptoms of oral cancer (p<0.001). Conclusion There is deficiency of knowledge among medical students about some aspects of oral cancer. Active involvement while examining patients and taking biopsies of malignant and premalignant lesions may help in improving students' knowledge about oral cancer.
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