Functional outcomes of Total Hip Replacement using modified Harris Hip Score

Background: Total hip replacement (THR) is a common surgery for relieving pain and improving the quality of life in patients with moderate to severe hip arthritis. The primary reason for THR is severe hip osteoarthritis, when conservative measures fail to relieve pain. The objective of the study was to examine functional outcomes, indications, and complications of THR using mHHS at different stages. Methods: A prospective observational study was carried out at the Department of Orthopedics, National Trauma Center, NAMS, from September 2019 to December 2020. The study included first 35 hips of 35 patients who underwent Total Hip Replacement at our hospital and met the inclusion criteria. Follow-up assessments were conducted at 6 weeks, 3 months, and 6 months after the surgery. Each visit involved thorough clinical and radiological examinations, as well as documentation of the mHHS chart. All continuous variables were expressed as mean ± standard deviation and two sample t test was used to compare means of two sub groups. Results: The study enrolled participants aged 26 to 66, with 60% male and 40% female. Right sided involvement was observed in 55% of cases, while the left side was affected in 45%. The most common reason for surgery was osteoarthritis caused by avascular necrosis of the femoral head. The average preoperative mHHS was 28, which increased to 64 at six weeks, 86 at three months, and 92 at six months. The study found that 80% of participants achieved excellent results. Complications, including a 2.85% dislocation rate, were reported. Conclusion: THR is a safe and effective procedure, providing excellent functional outcomes and minimal complications when performed carefully and precisely. Long-term studies are needed to investigate late complications and further establish the efficacy of the implants and the procedure

Peripartum Cardiomyopathy and Systemic Lupus Erythematosus Carditis, a diagnostic dilemma

A young woman at 8 months postpartum presented with dyspnoea, orthopnoea and swelling of lower limbs in which physical examination, chest radiography and echocardiogram were suggestive of acute congestive heart failure with left ventricle dilatation and dysfunction. A suspicion of peripartum cardiomyopathy was made and treated with conventional drug therapy but the patient continued to develop multiple episodes of heart failure. Over time she developed fever and polyarthritis following which autoantibodies, complement level and 24-hour urinary protein were done which helped us to make the diagnosis of Systemic Lupus Erythematosus (SLE) nephritis. The patient was started on high dose corticosteroids. However, after a week, patient developed cardiogenic shock following which intravenous pulse Cyclophosphamide was started and the patient improved clinically and biochemically.</jats:p

Screening and Identification of Thermotolerant and Osmotolerant Bacillus amyloliquefaciens BKHE Isolated from Kinema of Eastern Nepal for Alkaline Protease Production

Alkaline protease is one of the most important industrial enzymes which are excessively used in the detergent industry, food industry, feed industry, pharmaceutical industry, leather industry, etc. 60% of the produced alkaline protease is consumed by the detergent industry alone. In the present study, bacterial isolates that can produce alkaline protease for purpose of bio-detergent were screened among the isolates isolated from kinema (an alkaline fermented food of eastern Nepal). Selected bacterial isolates were further screened for hemolysis activity and the production of other hydrolytic enzymes. Four bacterial isolates selected were tested for their capacity to produce alkaline protease in five different fermentation mediums. Isolate BKHE produces a high amount of alkaline protease (0.4705 ± 0.035 U/mL/min) in fermentation medium M2 (sucrose, 11 g/L; yeast extract, 5 g/L; and KNO3, 5.2 g/l, pH 9). The selected isolate was identified as Bacillus amyloliquefaciens BKHE based on 16S rRNA sequencing and phenotypic features. This bacterial strain was also found to be thermotolerant (confluent growth at 50°C) and salt tolerant up to 10% NaCl concentration. With its versatile ability, bacterial isolate or purified enzymes have potential applications in the food and detergent industry

Nimesulide-induced Erythema Multiforme Major: A Case Report

Erythema Multiforme Major (EMM) is a rare hypersensitivity reaction that primarily affects the skin and mucosa, typically self-limiting. This case discusses a patient who developed severe EMM lesions after consuming nimesulide, a non-steroidal anti-inflammatory drug (NSAID), for abdominal discomfort. Patient was admitted to the hospital, the drug was discontinued, and supportive measures such as pain management and fluid replacement were initiated. This case, being the first to identify nimesulide as a possible trigger for EMM, aims to contribute to the growing body of knowledge on this topic. It emphasizes the need for vigilance and swift intervention for unusual drug reactions

Functional Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis in Distal Tibial Fracture

Background: Traditional plating techniques for distal tibia fractures may produce periosteal stripping and microcirculatory damage, which may frequently induce infection, nonunion or both. Treatment of these injuries using minimal invasive percutaneous plate osteosynthesis (MIPPO) technique may minimize soft tissue injury and damage to the vascular integrity of the fracture fragments. The objective of our study was to assess the clinical result of MIPPO for distal fracture of tibia. Methods: A total of 30 patients of distal tibia fracture treated with MIPPO with Locking compression plate (LCP) Technique at National Trauma Center, Kathmandu were studied during a period of one year. Patients were followed up on 2nd post-operative week and then at an interval of 4 week till 6 months. Tenny and Weiss clinical assessment criteria was used in each follow up. Results: In our study, mean age of the patients was 36.9 year with standard deviation ± 9.4 and majority of them were male (60%). The mean time for radiological union of bone was 17 weeks. In final follow up, 2 cases had excellent result, 23 cases had good result and 5 cases had fair results. No case had poor functional outcome. Conclusion: MIPPO offers a reliable and reproducible technique for treating distal tibia fractures with intra-articular or peri-articular fracture extension. This technique avoids significant complications compared to more commonly used internal and external fixation techniques for such injuries. This procedure is associated with good functional outcomes regarding the ankle range of motion