Antihypertensive Medications Use among Chronic Hemodialysis Patients Visiting the Outpatient Department of Nephrology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Anti-hypertensive medications are prescribed for the management of high blood pressure which is the leading cause of mortality in chronic hemodialysis patients. The objective of our study was to find out the prevalence of anti-hypertensive medication use among chronic hemodialysis patients visiting the outpatient Department of Nephrology of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among chronic hemodialysis patients visiting the Department of Nephrology of a tertiary care centre from 2 April 2022 to 30 September 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 062-078/079). A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: The prevalence of anti-hypertensive medications use was present in 102 (97.14%) (93.95-100, 95% Confidence Interval) patient undergoing hemodialysis. The three common drugs prescribed for hypertensive patients were amlodipine 79 (77.45%), torsemide 59 (57.84%), and prazosin 48 (47.05%). Conclusions: The prevalence of antihypertensive medication use among patients undergoing hemodialysis was higher than other similar studies done in similar settings. Keywords: anti-hypertensive drugs; hemodialysis; prevalence.

Noise-induced Hearing Loss among Patients Requiring Pure Tone Audiometry Evaluation in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Noise-induced hearing loss is a type of sensorineural hearing loss caused by long-term exposure to loud noise. This study provides insight into hearing loss problems the general population faces. The study aimed to find out the prevalence of noise-induced hearing loss among patients needing pure tone audiometry evaluation in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from 1 January 2021 to 30 July 2021 among patients requiring pure tone audiometry evaluation in the outpatient Department of Otorhinolaryngology in a tertiary care centre. The study was conducted after ethical approval from Institutional Review Committee (Reference number: 2812202001). Pure tone audiometry was used to diagnose noise-induced hearing loss. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 690 patients, 14 (2.02%) (0.97-3.06, 95% Confidence Interval) were diagnosed with noise-induced hearing loss. Conclusions: The prevalence of noise-induced hearing loss among patients requiring pure tone audiometry evaluation was similar to other studies conducted in similar settings. Keywords: audiometry; noise-induced hearing loss; tinnitus.

Middle Ear Barotrauma among Licensed Para-pilots of a Metropolitan City: A Descriptive Cross-sectional Study.

Introduction: Middle ear barotrauma is a tissue injury to the ear secondary to inadequate pressure equalisation between the middle ear and the external environment. Paragliding, though an exciting sport, has its own risks and hazards. Para-pilots experience a variety of ear-related symptoms due to pressure discrepancies between the middle ear and ambient air. Middle ear barotrauma amongst para-pilots is a common yet neglected problem. The aim of this study was to find the prevalence of middle ear barotrauma among licensed para-pilots of a metropolitan city. Methods: A descriptive cross-sectional study was conducted amongst para-pilots practising in different paragliding companies in a metropolitan city. The study was conducted from 10th October, 2021 to 22nd October, 2021 after getting ethical approval from the Institutional Review Committee (Reference number: 0410202109/2021). A sample size of 76 participants was taken using convenience sampling technique. Data was collected from participants after performing an otoscope examination. The data were entered into Microsoft Excel version 2016 and analysed using the Statistical Package for the Social Science Version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean and standard deviation for continuous data. Results: Out of 76 participants, the prevalence of middle ear barotrauma was 10 (13.2%) (5.58-20.81 at 95% Confidence Interval). Conclusions: The prevalence of middle ear barotrauma was similar to other studies done in similar settings. Keywords: barotrauma; eustachian tube; Nepal; pilots.

Comparison of Clinical and Functional Outcome of Cold Steel Dissection versus Coblation Technique in Tonsillectomy.

BACKGROUND: To ameliorate the intra and post-op morbidities associated with newer techniques for tonsillectomy like coblation has been introduced in the recent past. This study was aimed to compare the cold steel dissection with the coblation technique with regards to its effectiveness and safety. METHODS: An observational comparative study was carried out in 90 patients undergoing tonsillectomy between July 2018 to December 2019. Forty-five patients in each group of cold steel dissection and coblation were compared between the operative time, intraoperative blood loss, post-operative pain, post-operative bleeding and return to work. Intraoperative blood loss was measured using a standard sized gauge piece whereas post-operative pain was measured using a visual analogue scale (0-10) at first and third day of surgery. RESULTS: The age and sex were comparable between the groups. The mean operation time (31.40±4.52 min versus 17.02±3.11 min), intraoperative blood loss (27.20±7.16 ml vs 9.73±5.52 ml), post-operative pain in day 1 (8.02±1.27 vs 4.98±1.03), post-operative pain in day 3 (4.80±0.89 vs 2.76±0.74) and time needed to return to work in days (10. 31±1.29 vs 6.76±1.20) were statistically significant in coblation group (p<0.000). Primary and secondary post-operative haemorrhage rates were similar in both the groups. There was no return to theatre for hemostasis. CONCLUSIONS: Coblation tonsillectomy significantly reduces operation time, intraoperative blood loss, post-operative pain (day1 and 3) and time required to return to work . This technique doesn't differ from cold steel dissection tonsillectomy in terms of primary and secondary post-operative hemorrhage.

Anatomical Positions of Superior Parathyroid Gland with regard to the Zuckerkandl Tubercle in Patients Undergoing Thyroidectomy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Zuckerkandl tubercle is a prominent anatomical structure of the thyroid lobe. Identification and preservation of recurrent laryngeal nerve and parathyroid glands during thyroid surgery can be made easier through assessment of their relationship with the Zuckerkandl tubercle. This study aims to determine the anatomical relationship between Zuckerkandl tubercle and superior parathyroid in patients who underwent thyroidectomy in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted at a tertiary care hospital of Nepal following ethical clearance from the Institutional Review Committee (Reference no: 0106201804) among patients who underwent thyroid surgery between July 2018 to February 2020. Convenience sampling was used for collecting data and was entered in Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency andproportion for binary data. RESULTS: Out of 59 cases, 27 (96.4%) of superior parathyroid on the left were at the 1-2 o'clock position, and 28 (90.3%) of superior parathyroid on the right were at 10-11 o'clock position. On the left side, the superior parathyroid was adhered to Zuckerkandl tubercle in 10 (35.7%), was within 5 mm in 16 (57.1%), and was >5 mm away from Zuckerkandl tubercle in 2 (7.14%). On the right side, the superior parathyroid was adhered to Zuckerkandl tubercle in 12 (38.7%), was within 5 mm in 13 (41.93%), and was >5 mm away from Zuckerkandl tubercle in 6 (19.3%). CONCLUSIONS: Zuckerkandl tubercle has a consistent relationship with the superior parathyroid and can be used as an important landmark for identifying superior parathyroid during thyroid surgery.

Septorhinoplasty among Patients who Visited the Outpatient Department of Otolaryngology-Head and Neck Surgery of a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: The nose is the central most part of the face, so any nasal deformities may cause a high level of psychological distress on one's quality of life. Septorhinoplasty is a surgical procedure used to correct both functional as well as aesthetic problems of the nose. It enhances facial harmony and increases self-confidence. The objective of this study is to find out the prevalence of out-patients who underwent septorhinoplasty in a tertiary care centre in Nepal. METHODS: A descriptive cross-sectional study among 5,760 patients who visited the outpatient department of Otolaryngology-Head and Neck Surgery of Kathmandu Medical College from April 2019 to September 2020. Ethical approval was taken from the Institutional Committee of Kathmandu Medical College. A convenient sampling technique was used. The preoperative and postoperative assessment was done with the help of a rhinoplasty outcome evaluation questionnaire. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of septorhinoplasty was 117 (2.03%) during the study period (95% Confidence Interval= 1.66-2.40). Among 117 patients, 67 (57.3%) were males and 50 (42.7%) were females. Among 117 patients, 85 (72.6%) patients underwent an open approach, while 32 (27.4%) patients underwent closed approach rhinoplasty for the correction of both aesthetic and functional problems. CONCLUSIONS: This study concludes the prevalence of septorhinoplasty is low which may be due to the COVID-19 pandemic during the study period.

Trans-oral Extra Tonsillar Approach of Styloidectomy for Treatment of Eagle's Syndrome among Operated Cases of the Department of Otolaryngology-Head and Neck Surgery at a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Eagle's syndrome is a poorly understood clinical entity that has variable presentations like recurrent throat pain or foreign body sensation, dysphagia, or facial pain. With a confirmed diagnosis, a surgical approach is considered appropriate for its treatment. This study aims to find out the prevalence of trans-oral extra tonsillar approach of styloidectomy among the operated cases of Department of Otolaryngology-Head and Neck Surgery at a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted among 1,475 who underwent surgery at the Department of Otolaryngology-Head and Neck Surgery in a tertiary care center of Nepal between July 2018 to September 2020 after receiving the ethical clearance from the Institutional Review Committee (Reference number: 0106201802). Convenience sampling was done and data was entered in Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Among 1,475 patients enrolled in the study, 24 (1.62%) patients (95% Confidence Interval= 0.97-2.26) underwent trans-oral extra tonsillar approach of surgery for Eagle's syndrome during the study duration. CONCLUSIONS: The prevalence of styloidectomy among the operated cases of our study is low in comparison to other studies done in similar settings. Transoral extra tonsillar approach can be considered as a novel approach for surgical removal of the styloid process in Eagle's Syndrome.

Distance of Recurrent Laryngeal Nerve in Relation to Superior Parathyroid Gland During Thyroid Surgery.

BACKGROUND: In thyroid surgery, it is essential to identify and preserve recurrent laryngeal nerve to avoid injury to the nerve which will lead to nerve paralysis or paresis. The meticulous dissection of recurrent laryngeal nerve is important for careful identification and preservation of the nerve to prevent post operative vocal cord paresis and hoarseness. METHODS: A single centre prospective, cross sectional study was conducted from May 2019 to January 2021 in Department of ENT and Head and Neck surgery in Kathmandu Medical College Teaching Hospital. The data on distance between recurrent laryngeal nerve and superior parathyroid gland during thyroidectomy were collected. RESULTS: The mean distance of recurrent laryngeal nerve in relation to superior parathyroid gland during thyroid surgery was 5.03±1.79 millimeters. The recurrent laryngeal nerve lies within 5mm of superior parathyroid gland in 83.05% cases and between 6 and 10mm in 15.25 % of cases. CONCLUSIONS: The recurrent laryngeal nerve is found in the close proximity to the superior parathyroid gland. The visual method of identification of recurrent laryngeal nerve can be widely adopted in thyroid surgery to prevent recurrent laryngeal nerve injury.

Accuracy of Glucose Meter among Adults in a Semi-urban Area in Kathmandu, Nepal.

INTRODUCTION: Glucose meters are gaining popularity in monitoring of blood glucose at household levels and in health care set-ups due to their portability, affordability and convenience of use over the laboratory based reference methods. Still they are not free of limitations. Operator's technique, extreme temperatures, humidity, patients' medication, hematocrit values can affect the reliability of glucose meter results. Hence, the accuracy of glucose meter has been the topic of concern since years. Therefore, present study aims to evaluate the analytical and clinical accuracy of glucose meter using International Organization for Standardization 15197 guideline. METHODS: A community based descriptive cross-sectional study was conducted in Kapan, Kathmandu, Nepal in April 2018. Glucose levels were measured using glucose meter and reference laboratory method simultaneously among 203 adults ≥20 years, after an overnight fasting and two hours of ingestion of 75 grams glucose. Modified Bland-Altman plots were created by incorporating ISO 15197 guidelines to check the analytical accuracy and Park error grid was used to evaluate the clinical accuracy of the device. RESULTS: Modified Bland-Altman plots showed>95% of the test results were beyond the acceptable analytical criteria of ISO 15197:2003 and 2013. Park Error Grid-Analysis showed 99% of the data within zones A and B of the consensus error grid. CONCLUSIONS: Glucose meter readings were within clinically acceptable parameters despite discrepancies on analytical merit. Possible sources of interferences must be avoided during the measurement to minimize the disparities and the values should be interpreted with caution.

Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity.

INTRODUCTION: Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope. The study was done to assess and clean postoperative canal wall down mastoidectomy cavities with endoscope and compare with oto-microscopy. METHODS: This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant. RESULTS: The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely. CONCLUSIONS: Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.

Acoustic Analysis of Voice in School Teachers.

INTRODUCTION: The term 'voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage. The objective of the study is to assess the quality of voice of school teachers before and after teaching practice. METHODS: Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time. RESULTS: We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P<0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P<0.001) and maximum phonation time value (P<0.01) after teaching practice. CONCLUSIONS: Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.

Diode Laser Turbinate Reduction in Allergic Rhinitis: A Cross-sectional Study.

INTRODUCTION: Turbinate reduction procedures are recommended for inferior turbinate hypertrophy in allergic rhinitis that fail to respond to medical therapy. Several modalities like turbinectomy, submucosal resection and tissue ablation are available for this purpose. The study aimed to evaluate the effectiveness of diode laser in the treatment of symptomatic inferior turbinate hypertrophy in allergic rhinitis and explore complications related to the procedure. METHODS: This descriptive cross-sectional study was carried out in a tertiary care centre. The study enrolled 60 patients with inferior turbinate hypertrophy with failure of medical therapy. Inferior turbinate reduction was performed under local anaesthesia using diode laser. All the patients were evaluated subjectively for various nasal symptoms using visual analogue score scale preoperatively and during postoperative visit at three months. RESULTS: The age ranged from 16 to 47 years with median age of 28 years. Twenty nine were male and thirty one were female. There was significant improvement in symptoms like nasal obstruction, nasal discharge, sneezing and decreased sense of smell. Immediate post-operative pain, crusting and persistent nasal discharge were observed as complications of the procedure. However, there was no incidence of mucosal oedema and synechiae formation in our study. CONCLUSIONS: Diode laser turbinate reduction procedure is safe, minimally invasive and effective in relieving the symptoms associated with inferior turbinate hypertrophy in allergic rhinitis resistant to medical therapy and can be performed on a day care basis under local anaesthesia.

Diode Laser Reduction of Symptomatic Inferior Turbinate Hypertrophy.

INTRODUCTION: Inferior turbinate hypertrophy refractory to medical management is one of the commonest problems encountered by ENT surgeons all over the world. Diode Laser turbinate reduction is a safe, minimally invasive, cost-effective procedure that helps in relieving the symptoms associated with it and can be performed on a day care basis under local anesthesia. The objective of this study is to measure the effectiveness of Diode laser in treatment of symptomatic ITH. METHODS: Fifty patients with symptomatic inferior turbinate hypertrophy, age ranging between 15-45 years were enrolled in the study. Symptom assessment was done with the visual analogue scale. Portable Diode laser was used. Patients were followed up after 1 week and 1 month of surgery. During each postoperative visit, symptoms were reassessed using VAS and postoperative morbidity were noted. RESULTS: Out of fifty patients, all the patients had nasal obstruction and 42 had nasal discharge and by the end of 1 month 43 (86%) and 37 (88%) patients had relief of symptoms respectively. Excessive sneezing was found in 45 patients, 39 (86.6%) patients got benefitted. Out of 18 patients, 15 (83.3%) patients had decreased snoring at 1 month post-op. Similarly, 24 patients had headache, 20 (83.3%) patients had decrease in severity. Hyposmia was seen in 19 patients, 10 (52.6%) patients had improvement in olfaction. CONCLUSIONS: Diode laser turbinate reduction for symptomatic inferior turbinate hypertrophy is one of the safest procedures that can be done under local anesthesia on OPD basis with significant relief of symptoms and with minimal complications.

Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenoma: A Multi-disciplinary Approach.

BACKGROUND: The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has now revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. However, it involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images hence demands training and inter-disciplinary approach. Here we present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas. METHODS: This prospective study was jointly conducted in the departments of ENT and Neurologicals surgery Kathmandu Medical College, Nepal, from September 2014 to August 2016. The endoscopic approach to the sphenoid sinus was performed by an Otolaryngologist and ablative surgery by Neurosurgeon. The ease of procedure, intra operative challenges, surgical cure, post-operative cerebro spinal fluid (CSF) leaks and postoperative complaints were analyzed. RESULTS: Sixteen consecutive patients with pituitary adenoma (macro adenoma=13, micro adenoma =3) were analyzed. There were three intraoperative CSF leak, managed successfully. Two patients developed transient diabetes insipidus and surgical cure rate was 90%. No case had to be switched over to traditional microscopic route due to technical failure. There was no mortality. CONCLUSIONS: The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in Nepal, equipped with endoscopic sinus surgery and endoscopically trained ENT and Neurosurgeons. A multi disciplinary approach provides good access, greater tumor excision and excellent postoperative follow up.