Morphoea Profunda Presenting with Atrophic Skin Lesions in a 26 Year Old Female: A Case Report

Morphoea Profunda is a rare variant of Morphoea that presents clinically as a solitary fibrotic plaque. Morphoea Profunda presenting with atrophic lesions has rarely been reported in literature. We report the case of a 26 year old Nepalese lady who presented to us with multiple non-inflammatory atrophic lesions on her body without significant skin induration, pigmentation and texture change. The findings on histopathology confirmed a diagnosis of Morphoea Profunda. Hence, Morphoea Profunda should be considered in the differential diagnosis of anyone presenting with asymptomatic atrophy of the skin

Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively. Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment. Results: Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883). Conclusions: Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case. Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis

Assessment of Food Intake and Nutritional Status of Children Attending Montessori School of Pokhara Valley

Introduction: Childhood is a time of critical growth in which proper nutrition is necessary. Children afflicted by sustained poor nutrition are at greater risk for obesity, mental and emotional health problems and a failure to thrive academically. The objective of this study was to assess the food intake of children attending the Montessori school. Methods: A cross sectional study was carried out among 235 children of 3-5 years from twenty Montessori schools. Data were collected using simple random sampling. A weighed food was recorded from the consumption of children during a day of their stay in the Montessori school along with the observation of food consumption. Results:  More than every nine out of ten children (92.8%) didn’t meet calorie requirement. The mean food intake during their stay in Montessori was 368.81±111.89 grams. Mean calorie, fat, protein, retinol and beta carotene intake were 540±150.5 Kcal, 10.04±5.6 grams, 13.25±5.49 grams, 49.76±32.6 grams, 135.75±274.67 grams respectively. Dietary fat (OR=3.7, 95% CI; 1.8, 7.5) and protein consumption (OR=2.2, 95% CI; 1.1, 4.4) were significantly associated with overweight status of children. Conclusion: The amount of nutritive foods should be increased so that the children meet adequate amount of nutrient required for the proper growth and development of their body. Since the association between dietary fat and protein intake with overweight condition was observed the excess use of fat providing foods should be limited and protein rich foods should be provided as per the Recommended Dietary Allowance (RDA) of Montessori children. Keywords: Food intake, nutritional status, children, Nepa

Pre-operative Prediction of Dif cult Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed.Though LC have become safer and easier at times it can be dif cult. Dif cult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. Identication of dif cult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict dif cult LC preoperatively. Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict dif cult LC which was compared with operative assessment. Results: Sensitivity and speci city of the preoperative scoring for dif cult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically signi cant to predict dif cult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883).  Conclusions: Preoperative scoring system can be used to predict dif cult LC. Surgeons can plan operation based on predicted difculty. Patients and relatives can be counselled preoperatively for the possibility of dif cult operation, prolonged hospital stay and increased cost in predicted difcult case. Keywords: Dif cult cholecystectomy; Laparoscopic cholecystectomy; Symptomatic cholelithiasi