Pattern of Acute Abdominal Pain Presenting to Emergency Department of Karnali Academy of Health Sciences: Hospital Based Cross Sectional Study

Introduction: Acute abdominal pain (AAP) is a medical emergency, characterized by pain arising from the abdominal area, of non-traumatic origin with a maximum duration of five days. Timely evaluation of acute abdominal pain (AAP) is important as it may determine the long-term prognosis. This study aims to evaluate various aspects of acute abdomen pain among patients who presented to the emergency department (ED) of Karnali Academy of Health Sciences (KAHS) in an attempt to determine the pattern and prevalence of AAP in a rural Karnali region of Nepal. Methodology: A hospital based retrospective study was conducted in KAHS. Data was collected from admission registers in ED that contained information of patients. Patients presenting to the ED during a period of six months (May 2020- October 2020) with acute abdominal pain, non-traumatic in origin were included in the study. Statistical analysis was done using SPSS version 17. Frequency and percentage was used for analysis Result: A total of 215 patients had visited the ED with acute abdomen. Acute gastritis (48.6%) was the most common cause of acute abdominal pain in ED followed by acute appendicitis (11.6%). A total of 70 cases (32.5%) had purely surgical nature of aetiology. Acute abdominal pain was seen equally distributed between both genders. Patients of AAP mostly belonged to the middle age group (44.6% in an age group of 15-30 years). Conclusion: Acid peptic disease in the form of acute gastritis is common among people living in rural Karnali region. Acute appendicitis represents the most common cause of acute abdomen, often requiring surgical intervention

Elastic stable intramedullary nailing in pediatric diaphyseal forearm bone fracture

Background: Pediatric forearm bone fracture present significant challenges where most of them are managed with closed reduction and casting. Irreducible, unstable and open fracture usually requires operative stabilization. Intramedullary nailing is considered minimal invasive however it is not free of complication. The aim of this study is to analyze the outcome and complications after elastic stable intramedullary nailing in pediatric diaphyseal forearm fracture.Methods: A descriptive observational study was carried out for four years (2013-2016) in diaphyseal pediatric forearm fracture stabilized with titanium elastic stable intramedullary nailing. Final range of motion, complications and outcome were assessed using Clavien-Dindo classification modification appropriate for orthopedic surgery.Results: We report the outcome of 36 patients with complete medical records. Closed reduction and nailing was successful in 25 patients (69.4%) whereas eleven patients (30.6%) required open reduction (both radius and ulna in 6 patients 16.7%, ulna in 3 patients 8.3% and radius in 2 patients 5.6%). Radiological union was achieved at an average of 7.75±1.5 weeks (range 6 to 16 weeks). Forearm rotation was limited in 7 patients with average loss of 16° pronation and 18° supination. The overall rate of complication was 22.2%. According to Clavien-Dindo classification excellent results were noted in 29 patients (80.6%), good in 3 patients (8.3%) and fair in 4 patients (11.1%). Conclusions: Elastic intramedullary nailing in pediatric diaphyseal forearm bones fracture is minimally invasive with low rate of complication and the outcomes are fair to excellent

Impact of Covid-19 Pandemic on General Surgical Services at Karnali Academy of Health Sciences

Background: Covid-19 pandemic that started from Wuhan China in 2019 December has made serious impact in the general wellbeing of people as well as the services provide by the health care institutions all over the world. This study aims to identify the impact of Covid-19 in the general surgical services provided by Karnali Academy of Health Sciences. Methodology: This was a retrospective study conducted at Karnali Academy of Health Sciences (KAHS), Jumla from 16th September 2019 to 15th September 2020 A.D (Ashoj 2076 to Bhadra 2077 B.S.). The data were obtained from records of various departments concerned with the delivery of the surgical services at our Hospital, which were then extracted to the Microsoft Excel and analysed. Results: Total 5,678 patients received General surgical services and the number of cases in each services remains somewhat consistent before lockdown however they tend to vary after lockdown. The average OPD cases decreased from 373.33 before to 223.33 after lockdown and average surgeries performed were considerably decreased from 64 to 28. The average emergency services per month (160 vs. 188.67) and ICU admission (3.67 vs. 8.67) showed increment, however ward admissions (48 vs. 45) were fairly constant. The elective surgeries decreased considerably reaching to Zero during Apr/May and May/June periods. Average Emergency surgeries per month were 34.5 before lockdown and 41.14 after lockdown; and average elective surgeries per month were 29.5 before and 4 after lockdown. Conclusion: The decrease in surgical services especially Out Patient Services and surgical procedures were the known results of the Corona Virus pandemic however the emergency and ICU services were maintained in usual capacity to both provide essential services and to minimize the risk of Covid -19 transmission

Profile of Patients under Mechanical Ventilation in ICU during COVID-19 Pandemic: a Hospital Based Study

Background: COVID-19 has become unprecedented challenge to ICU management. The measures for containment of the disease and mitigation can be possible only with a proper and organized planning. This study was conducted to evaluate the profile of mechanically ventilated patient in ICU of a Hospital in remote high altitude region during this pandemic. Methods: A cross-sectional study was done in patients who were admitted and managed with intubation and mechanical ventilation in ICU of Karnali Academy of Health Sciences (KAHS). Data were collected and filled in per-forma. Data were filled in Microsoft Excel and analysis done. Result: Most of the cases were adult males with 50% average intubation days less than five. Out of the total 42 cases 67% were intubated for inadequate airway protection and 33% `for respiratory failure. PCR test for COVID-19 was done for 50% of cases and one patient got positive result. Mortality was around 50% among intubated patients in ICU. Conclusion: ICU services at Karnali Academy of Health Sciences have been provided for both COVID and non-COVID patients during the pandemic. Referral hospital ICUs in remote part are important in management of serious cases of those areas during any pandemic so they should be well prepared. Keywords: COVID-19, intubation, mechanical ventilation, pandemic

de Quervain’s Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study

Introduction: de Quervain’s disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain’s disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain’s disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain’s disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Results: Out of 9600 orthopaedic outpatients, de Quervain’s disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). Conclusions: The prevalence of de Quervain’s disease was similar when compared to other studies conducted in similar settings

Implementing a daily CME at a rural primary care hospital in Nepal

Fostering a culture of continued learning at healthcare facilities is a global priority for healthcare systems performance, patient safety, and quality improvement. In low- and middle-income countries, continuing medical education activities are almost non-existent in rural areas. National professional academies tend to be focused almost exclusively at major teaching hospitals in urban centers. In addition to playing a central role in healthcare provision, rural district-level hospitals are formative for many young healthcare professionals who are posted there for mandatory government service. The district hospital thus represents an important opportunity to be a center for learning.   Methods We conducted a retrospective case study to describe the implementation of a continuing medical education program at a district-level hospital in rural Nepal. The particular modalities of continuing medical education include didactic lectures, case presentations, and morbidity and mortality conferences, presented by physicians and mid-level providers.   Results             During the first twelve months of the program, 155 sessions, or 73% of scheduled sessions, were conducted as planned. Ongoing challenges to the long-term success of the program include dedicated leadership time for session preparation and presenter mentorship, and improving participatory engagement across multiple clinician cadres.   Conclusions             Building a robust continuing medical education program in rural district hospitals is feasible, and has great potential as a mechanism of developing a professional and sustainable cadre of healthcare workers in these settings. Greater investment in these types of programs may improve healthcare worker satisfaction and retention, thereby improving access to care in these remote areas

A rare case of neglected paediatric elbow dislocation treated with open reduction in tertiary care rural hospital of Nepal

Old unreduced dislocation of elbow is rare1. However, they remain rather frequent in developing countries, because of the recourse of patients to the traditional medicine.2 Term  ‘Unreduced’ is defined as those posterior elbow dislocations not treated within 3 weeks of injury.3These elbows are fixed in either extension or flexion with only a few degrees of flexion, supination, and pronation, and have a non-functional range of movement for activities of daily living.3,4The time since injury and patient age determine the mode of treatment.5 The likelihood of restoring useful function of the elbow by open reduction alone is inversely proportional to the time since injury.6There are many ways to treat chronic dislocation or fracture- dislocation of the elbow, including ORIF, excision arthroplasty, replacement arthroplasty, arthrodesis, and hinged external fixators.7 There has been considerable disagreement about the impact of such variables as the duration of the untreated dislocation, the age of the patient, the method of repair or reconstruction of the collateral ligaments, the performance of triceps or biceps-lengthening, and postoperative mobilization.8,9`

Orthopedic Services during Covid-19 at Rural Tertiary Care Hospital, Jumla, Nepal

Background: World Health Organization (WHO) declared first pandemic caused by group of corona virus family, severe acute respiratory syndrome corona virus 2(SARS- CoV-2) on late  20201.One of the major challenges during the evolving COVID-19 pandemic was to deliver continuity of care to outpatients in the trauma and orthopaedic department. With increasing pressure on staffing and hospital resources, it’s a great challenge to deliver regular services on outpatient and inpatient departments. So, analysis of orthopaedic and trauma service during corona may provide overview of specialist care and its challenges during corona pandemic. Methods: All patients coming to Karnali Academy of Health Sciences from 14 March 2020 to 16 Sept 2020 were included and analyzed in terms of highest number of OPD, inpatient and OT cases. Clinical profiles, causes of admission, type of procedures were analyzed. Data analysis was done using excel and SPSS version 17.       Results: Result were analysed on the basis of patients coming to OPD, Ward and Operation theater during 14 March 2020 to 16 Sept 2020.In OPD, out of 3035 cases, 27% was fracture .Majority of cases coming to OPD were male (57%).Total admission in orthopedic ward during this period was 249.Out of which majority were male (72%) with fracture being most common cause of admission. Out of 212 surgical cases, 78.7% were male. Most common surgical procedure is K wire fixation for fracture. Maximum number of operation was done in the age group of 0-11 years which was 66 (31%), followed by age group of 11-20 years i.e. 42 (19.8%). Conclusion: Orthopedic service at Karnali Academy of Health Sciences has continuously been delivered amidst COVID 19 chaos. Orthopedics consists of major bulk of cases in our institution so proper strategy for preparation and handling of cases should be made during pandemic