Neurological Outcome of Early versus Late Surgery Following Cervical Spinal Cord Injury.

Background There are numerous retrospective studies and a few prospective studies to determine the neurologic outcome after early versus late surgical treatment for cervical spinal cord injury. Objective To compare the neurological outcome between early (within 72 hours after injury) and delayed (≥ 72 hours after injury) surgery in patients with cervical spinal injury. Method This is a retrospective analysis of the neurological outcome of early versus late surgery following cervical spinal cord trauma. Patients meeting appropriate inclusion criteria were divided into an early or a late surgical treatment group. The neurologic outcomes and other complications were recorded up to six months of follow-up. Result Overall, there was a significant difference in neurological status at presentation and at follow-up (p < 0.001). However, there was no statistically significant difference between the early versus late surgery groups (p-value 0.261) in terms of neurological outcome. Complications were found to be higher among those undergoing posterior surgical approach (OR = 23.75; 95% CI 2.65, 212.98) than those with anterior or combined approach (p=0.005). However, multivariate analysis of these variables failed to show any statistically significant difference between the two groups. Conclusion The timing of surgery does not alter the neurological outcomes and the development of complications significantly. The American Spinal Cord Injury Association (ASIA) status at the time of presentation is found to be the single most important factor correlating with the neurological outcome.

Experimental Life-Cycle of Varestrongylus eleguneniensis (Nematoda: Protostrongylidae) in a Captive Reindeer (Rangifer tarandus tarandus) and a Muskox (Ovibos moschatus moschatus).

The life-cycle of a recently described protostrongylid lungworm, Varestrongylus eleguneniensis, which infects caribou, muskoxen, and moose from Arctic and boreal regions of North America, was completed experimentally for the first time. A native North American slug species, Deroceras laeve, was infected with the first-stage larvae (L1) isolated from the feces of wild muskoxen to generate third-stage larvae (L3). These were administered to a captive reindeer calf (250 L3) and an adult captive muskox (380 L3). The prepatent periods for the reindeer and muskox were 56 and 72 days, respectively. Patency lasted for only 19 days in the reindeer, and fecal larval counts were very low (0.09-1.53 larvae per gram of feces). Patency in the muskox was at least 210 days, and likely over 653 days, and the fecal larval counts were higher (0.06-17.8 larvae per gram of feces). This work provides the first experimental completion of the life-cycle of V. eleguneniensis.

Amniotic membrane transplantation with and without limbal stem cell transplantation in chemical eye injury.

INTRODUCTION: Chemical burns of the eyes are one of the important causes of visual disability. Chemical burns particularly alkali burn may lead to gross limbal stem cell deficiency. Amniotic membrane transplantation with limbal graft is a good method for ocular surface reconstruction. CASE: A 39 years male presented to Biratnagar Eye Hospital after 5 months of chemical injury with redness, pain, photophobia and gradual loss of vision. His visual acuity was counting fingers close to face in both eyes. Amniotic membrane transplantation alone was done in right eye while in left eye limbal stem cell allograft was combined with amniotic membrane transplantation. There was not much visual improvement in right eye while left eye improved significantly to 6/60. CONCLUSION: Limbal stem cell graft with amniotic membrane transplantation can be an effective method of restoring vision and reducing symptoms rather than amniotic membrane transplantation alone in cases with total limbal stem cell deficiency following chemical burn.

Medico-social and behaviour problems amongst primary school children in rural area of Kathmandu, Nepal.

The objective of the study was medico- social and behaviour problems among primary school children of age (6-10 years) in rural area of Eastern part of Kathmandu Valley. Observational descriptive study was conducted in Govt. and Private Boarding Schools of rural Kathmandu Valley. Total 503 school children in primary school (6-10 years), Schools of rural area of Eastern part of Kathmandu, 4 were randomly chosen by systematic random technique. All students aged 6-10 years were included in the study. Complete data of each child was collected in a pre-designed, pre-tested questionnaire proforma. Out of 503 children, 230 (45.7%) boys and 273 (54.3%) were girls. Four hundred and thirteen (82.1%) children were found to be suffering from one or more morbid conditions. Hygienic condition was poor as in apparent look. Ninty nine (19.7%) respondents had lice and urticarial rashes in 47(9.3%), behaviour problems in 117 (23.3%), eye related diseases in 94 (18.7%), ear diseases in 413 (82.1%) and dental carries in 130 (25.8%) as observed in the study. Diseases that are seen among the school children are mostly preventable and the health of the child can be improved by promotion of hygienic practices through proper health education by the teachers and parents.

Allergic fungal rhinosinusitis in chronic rhinosinusitis.

BACKGROUND: Rhinosinusitis is the inflammation of nasal and paranasal sinus mucosa and is associated with mucosal alteration ranging from inflammatory thickening or gross nasal polyp formation.The main objective of this study is to determine the prevalence of allergic fungal rhino sinusitis among the patients having chronic rhino sinusitis with or without polyps who under goes functional endoscopic sinus surgery. METHODS: The patient with chronic rhinosinusitis with or without polyp who FESS were studied. Surgical specimens were sent for mycology and histopathological analysis for identification of fungus. RESULTS: Headache 41(82%) and nasal block 45(90%) were the commonest clinical presentation. Out of 50 patients, fungal elements were detected by KOH in 8(16%) of cases and histopathological examination in 11(22%) of cases. CONCLUSIONS: Allergic Fungal Rhinosinusitisis a common disorder in patients with chronic rhinosinusitis, it need different specific tests for the diagnosis, a more specific diagnostic tests are fungus culture, and IgE to fungal antigen and skin test are needed for definite diagnosis.

Diagnostic accuracy of fine needle aspiration cytology in thyroid swellings.

BACKGROUND: Proper management of the disease depends upon accurate diagnosis. Fine Needle Aspiration Cytology has become the investigation of choice because of its high accuracy, simplicity, minimal-invasiveness, quick result and reliability. METHODS: All the patients with thyroid disease, irrespective of age and gender, who underwent thyroid were studied. These patients had their fine needle aspiration Cytology was done in our centre. Detailed history, physical examination, routine investigations, radiological investigations (including CT scans when needed), hormonal assay, (T3, T4, TSH ), ultrasound of neck and FNAC were done. Pre- operative fine needle aspiration results were compared with histopathology results of operated specimen and then analyzed statistically to assess the sensitivity, specificity and accuracy of the result. RESULTS: There were total of 51 patients. Age ranges from 21 to 62 years. The study duration was from May 2006 to February 2011. Out of 51 patients, 82.35% (n=42) were females and 17.64% (n=9) were males. In 43 patients, FNAC showed benign lesions, of which 40 were true negative (TN) and three false negative (FN), which on histopathology reported malignancy. Remaining eight cases were diagnosed as malignancy on histopathology of which seven cases were true positive (TP), one case of false positive (FP) was detected in our study. Over all Sensitivity was 70% and specificity was 97.5% and accuracy of FNAC was 92.1%. CONCLUSIONS: FNAC should be performed in all cases of thyroid nodules because of its high sensitivity and specificity to differentiate benign from malignant lesions and counsel the patient as well as plan surgery accordingly. Expenditure, time and the hassle of revision surgery is minimized by the pre operative FNAC report.

Health problems and social consequences in teenage pregnancy in rural Kathmandu Valley.

Early marriage, less awareness of family life education, low socio economic condition and burden of large families in rural area are the contributory factors to high teenage pregnancy and its complications. A rural health centre based cross sectionals study was under taken over six month period among teenage (10-19 years) in the rural Kathmandu Valley. The study sample comprises (15-19 years old) 180 subjects. Data includes demographical variables as anemia, preterm delivery, abortion and hemoglobin. Preterm delivery cases within 37 weeks of gestation. Below 10 gm. of Hb was considered as anemia. The prevalence of anemia was quite high (56.66%) in teenage pregnancy. However severe (<7.9 gm) anemia was observed in 55.67% cases.

Successes rate of endoscopic dacryocystorhinostomy at KMC.

BACKGROUND: Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. OBJECTIVES: The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. MATERIALS AND METHODS: A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. RESULT: In six months' follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. CONCLUSION: Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR.

Use of double-balloon catheter in the management of epistaxis: a boon for the periphery.

BACKGROUND: Epistaxis is one of the most commonly encountered emergencies in ENT practise. It has been reported that almost 60% of general population experience epistaxis of small or large quantity in his /her lifetime(1). OBJECTIVE: The objective of this study was to compare the outcome of double balloon catheter to normal packing method for epistaxis. MATERIALS AND METHODS: An interventional study of 30 patients admitted in Kathmandu Medical College, Sinamangal, Kathmandu, Nepal from Baisak 2065 to Chaitra 2066 with bleeding from the nose were taken into study. These patients were analysed on the basis of duration of hospital stay, any related cause for epistaxis, modalities of treatment, success of balloon catheter etc. RESULT: Results with double-balloon catheter showed less hospital stay and better compliance by the patient. CONCLUSION: This study highlights that double-balloon catheter has a higher chance of acceptance by the patient and is better in the treatment of epistaxis. This method can be undertaken without anaesthetic assistance thus it is very feasible even in the most remote areas of our nation.

Common behaviour problems amongst primary school children in slum dwelling area of Kathmandu Valley.

A cross sectional observation study was carried out in primary school children of slum dwelling area of Kathmandu Valley which included 454 students. The aim of study was to find out morbidity in habit disorders in age group of 6-10 years so that early detection will be helpful to correct them to prevent it from further personality maladjustment. There was no statistical difference in gender wise habit disorders. The morbidity is due to multiple factors of physico- social environment. However severity of disease is not more here in this area.

Computed tomographic assessment of lateral lamella of cribriform plate and comparison of depth of olfactory fossa.

INTRODUCTION: Endoscopic sinus surgery is an upcoming branch in rhinological practice but with some major risks since it has to play around the skull base area. Lateral lamella of cribriform plate is the thinnest area of the skull base. Thus this study is undertaken to evaluate the height of lateral lamella of cribriform plate and the depth of olfactory fossae by the help of computed tomographic images. METHODS: Computed tomographic study of 50 patients was done in Advanced Imaging and Diagnostic center, Kathmandu Medical College. Coronal sections at the centre of infra-orbital foramina were taken as reference slide. The height of cribriform plate point was subtracted from the height of medial ethmoidal roof point to measure the length of lateral lamella of cribriform plates on both sides. RESULTS: The median height of LLCP in 100 slides was 2.8 mm. LLCP height was 0 to 3.9 mm in 86 slides, 4 to 7 mm in 12 slides and greater than 7mm in 2 slides. The LLCP length was greater in right side in 28 (56%) patients and was greater in left side in 19 (38%) patients. It was equal in both sides in only three patients (6%). CONCLUSIONS: As regards the length of LLCP; 0 to 3.9 mm length was most common. The olfactory fossa depth was more in the right side compared to the left side. Thus, right side is more vulnerable to injury during surgery. Thus adequate caution has to be exercised by the rhinological surgeon during endoscopic sinus surgery.

Incidence of tuberculosis in enlarged neck nodes, our experience.

OBJECTIVES: To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. MATERIALS AND METHODS: Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux's test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. RESULTS: Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 - 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. CONCLUSION: There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region.

Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type.

BACKGROUND: It is acknowledged that size and site of tympanic membrane perforation is proportional to degree of hearing loss but there are many studies which suggests otherwise. Persistent ear discharge is also supposed to deteriorate hearing level with passage of time. This study is carried out to find out the relation between size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. OBJECTIVES: The objective of this study is to study the effect of size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. METHODS AND MATERIALS: This is a cross-sectional prospective study conducted at Kathmandu Medical College, department of ear nose and throat from January till July 2009. One hundred patients aged between 8 to 60 years with pars-tensa perforations were included in the study. Detail clinical examination and history was carried out followed by hearing evaluation by audiometry was done in all cases. All the data is collected, statistical analysis is done using SPSS program and documented for study. RESULTS: One hundred patients with 119 perforated tympanic membrane, age ranged between 8 to 60 years, 44 males and 56 females were studied. Bilateral tympanic membrane perforation were seen in 19 patients, right sided perforation in 39 and left sided in 42 patients respectively. Large central perforation involving all four quadrants was the most common otologic findings seen in 72 ears (60.50%) whereas perforation in posterosuperior quadrant was the least common finding seen in 3 patients (2.52%). Significant relation is observed between site of perforation and degree of hearing loss; posterior placed perforations seem to have larger hearing loss. Ninety-five perforations (79.83%) showed more loss in low frequencies with larger air bone gap at low frequencies. The longer the duration of ear discharge, the more the hearing loss. CONCLUSION: The larger the perforation, the greater the decibel loss in sound perception. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss.

Comparison of chemical cautery (AgNo3) and steroid spray against SMD (submucosal diathermy) in the treatment of symptomatic inferior turbinate hypertrophy (ITH).

OBJECTIVE: To compare the efficacy of chemical cautery (AgNo3) and steroid nasal spray against SMD (submucosal diathermy) in the treatment of symptomatic Inferior Turbinate Hypertrophy (ITH). MATERIALS AND METHODS: Patients attending OPD in the department of ENT &HNS at KMCTH with symptomatic Inferior turbinate Hypertrophy were taken with their approval included for the study. Patients were divided into 2 Groups: in the first Group 25 patients were included and treated with chemical cautery (AgNo3) under Local Anaesthesia (LA), followed by steroid nasal spray for 3 months; in the second Group 25 patients were included and were treated with SMD (submucosal diathermy) under General Anaesthesia (GA).They all had history of use of topical nasal decongestant for different time period. Patients were followed up for 6 months. RESULTS: In Group 1, 16 patients complain of burning sensation for first week and 8 patients complain of continuous nasal blockage for 6 weeks.1 patient complain about inosmia for 2 weeks. In Group 2, nasal pain was complained by 17 patient for 2 weeks. 3 patients complain of persistent nasal blockage for 4 weeks. 3 patients complain of anosmia for 4 weeks. After completion of 6 months in Group 1, 20 patient has recurrent nasal blockage, whereas in Group 2, 10 patient has recurrent nasal blockage. Besides these, other symptoms noticed during initial phase did not appear. CONCLUSION: Chemical cautery (AgNo3) and steroid nasal spray is easy to follow, has less complication ,but failure rate is high, whereas SMD is procedure with less failure rate, but has to carried out under GA and has more discomfort postoperatively. For symptomatic inferior turbinate hypertrophy, where topical nasal decongestant has little role SMD is the choice of treatment for longer relief.

Comparison of sub mucosal diathermy and partial resection of Inferior turbinate in the treatment of symptomatic nasal valve blockage.

OBJECTIVES: to evaluate the efficacy of sub mucosal diathermy (SMD) and partial resection of inferior turbinate (PRIT) in the treatment of symptomatic enlarged inferior turbinates. STUDY DESIGN: prospective. METHODS: Forty patients of age group 18 -56 yrs with symptomatic enlarged inferior turbinates had given choices for SMD and PRIT. All the patients had history of failed medical treatment. RESULTS: Each twenty patients underwent SMD (group I), PRIT (group II), five pt of gr. I had to have anterior nasal packing after surgery for bleeding. Three pt complained of excessive rhinorrhoea for first 2 weeks while 3 pt of Group 1 complained of nasal blockage for 1 week even after intervention. In group 2, 5 pt had to have re-anterior nasal packing after pack removal. Both groups followed up for 6 months. Nine patients were lost in follow up, so excluded from the study. Following 6 months of follow up, 6 patient of gr. I had recurrence with nasal blockage and in gr. II none had recurrence. CONCLUSION: PRIT is better than SMD in long course; nevertheless it should be reserved for failed SMD, not as a primary option.

Surgical management of sinus tympani cholesteatoma.

OBJECTIVE: the aim of this study is to describe the extension of unsafe middle ear disease in the sinus tympani and to review the methods of surgical access to remove the disease from this area. METHODS: Of the 164 operated ears with unsafe chronic suppurative otitis media 64(39%) ears had variable disease extension into the sinus tympani and were included in the study. Sixty two ears underwent canal wall down (CWD) procedure while remaining two underwent tympanoplasty with bone work. RESULT: Five operated ears had deeper extension of the disease into the sinus tympani. And despite of different maneuver the complete removal of the disease could not be confirmed. Six ears (9.4%) had recidivism. CONCLUSION: The study emphasizes on the greater incidence of this disease extension into this difficult anatomical area and their complete removal may not be always possible. But one should require thorough knowledge and surgical expertise to work in this difficult area of posterior mesotympanum.