Surgical Outcome of Limberg's Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital.

Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps. Objective To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital. Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018. Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence. Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures.

Prevalence of Significant Tricuspid Regurgitation in Patients Planned for Mitral Valve Surgery in a Tertiary Center of Nepal.

Background Tricuspid regurgitation is frequently present in patients with mitral valve disease and most of this tricuspid regurgitation present are significant. Objective To find out the prevalence of tricuspid regurgitation in adult patients present in our hospital who are planned for isolated mitral valve surgery for mitral stenosis, mitral regurgitation or both. Patients with moderate and severe tricuspid regurgitation were considered as significant. Method This was the retrospective cross-sectional study performed at Shahid Gangalal National Heart Center of Nepal. All cardiac surgical patients scheduled for isolated mitral valve surgery during the 3 years' period from 2017 to 2020 were enrolled in the study and presence or absence of significant tricuspid regurgitation were recorded and analysed. Result Out of total patients 65% (663) of the cases with mitral valve pathology had significant tricuspid regurgitation. Out of the total mitral stenosis cases 70% were associated with significant tricuspid regurgitation, 62.6% of the cases of mitral regurgitation had significant tricuspid regurgitation and 64.8% of patients with combined mitral stenosis and regurgitation were associated with significant tricuspid regurgitation. Conclusion Significant tricuspid regurgitation is present in most of the cases with isolated mitral valve pathology. So routine tricuspid valve evaluation and repair if needed during mitral valve surgeries is recommended.

Improvement of Ejection Fraction in Patients undergoing Coronary Artery Bypass Grafting with Impaired Left Ventricular Function.

Background Myocardial revascularization surgery has shown better long term survival expectancy compared to medical therapy in patient with impaired left ventricular function. Objective To evaluate the change in ejection fraction after 90 days in patients who underwent coronary artery bypass surgery and had preoperative left ventricular ejection fraction of less than and equal to 45% in a single cardiac center of Nepal over the period of 2 years. Method Out of 82 eligible patients during 2 years, 3 patients expired in immediate postoperatively and 24 patients had loss of 90 days' follow up. So, they were excluded from the study. Total 55 patients were taken for the study for whom statistical analysis was done to compare preoperative ejection fraction with post-operative 90 days' ejection fraction. Result Single vessel disease was present in 2(3.6%) patients, double vessel disease in 7(12.7%) patients and triple vessel disease in 46(83.6%) of the patients. In 2(3.6%) patients 2 grafts, in 18(32.7%) patients 3 grafts, in 33(60%) patients 4 grafts and in 2(3.6%) patients 5 grafts were placed for revascularization. The mean left ventricular EF in preoperative patients was 37.12±5.69% which improved to 45.80±10.00% in postoperative follow up at 90 days which was statistically significant (p=0.000). Conclusion Surgical revascularization of myocardium in preoperatively impaired left ventricular function patients helps improve left ventricular ejection fraction postoperatively. So we suggest surgical revascularization in patient with low ejection fraction for improvement of myocardial function. Hence improve survival rate in these patients.

Multi-drug Resistant and Extended Spectrum ß-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples.

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension.Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

Laparoscopic Cholecystectomy: Conversion Rate and Associated Factors for Conversion.

Background Laparoscopic cholecystectomy is the standard surgical treatment of gall bladder disease. However, conversion to open cholecystectomy is inevitable in certain cases. Different centers has reported different conversion rate and factors associated with conversion. Objective To identify the conversion rate, postoperative complication and factors associated with conversion. Method This retrospective study included all laparoscopic cholecystectomy cases attempted in Dhulikhel hospital during the year 2015 and 2016. Records of all patients were reviewed to find out demography of the patients, indications of laparoscopic cholecystectomy, rate of conversion to open, underlying reasons for conversion and postoperative complications. Result Out of 644 cases of laparoscopic cholecystectomy, 452 (70.18%) were female and 192 (29.81%) were male with the mean age of 39 years. Over all conversion rate to open cholecystectomy was 1.86% with the frozen calot's triangle as the most common reason for conversion. The overall postoperative complication was found to be 1.24% with no major bile duct injury. Acute cholecystitis is a significant preoperative predictor for the conversion into open cholecystectomy. Conclusion Laparoscopic cholecystectomy can safely be done with low conversion rate and complication. Appreciation of the predictor factors help the patient and surgeon for appropriate treatment plan.

Normal Width of Third Ventricle In Nepalese Population: Assessment By CT Scan.

INTRODUCTION: Cerebral ventricular enlargement occurs as a natural aging process but also has been associated with many neurological disorders. Whether this enlargement is primary or secondary to these pathological conditions remains controversial. Objective of the study was to tabulate and create normal references values for maximum width of third ventricle in Nepalese population according to age group and gender. METHODS: MTW was determined in two hundred (112 males and 88 females) and age ranging between 1- 93 years who had normal Computed tomography scan of the head .The data collected was analyzed with statistical program IBM SPSS version 20. RESULTS: Measurements of MTW in both males and females of the normal groups revealed no significant difference. No significant difference in MTW was noticed till the age of 49 years. Significant differences were noticed between 49 - 93 years of age. CONCLUSIONS: This study corroborated well with normal MTW values published in literatures from other parts of the world. However normal values specific to our local population becomes more relevant in interpreting CT scan of head in Nepal.

Microalbuminuria among type-2 diabetes mellitus patients in Pokhara, Nepal.

Microalbuminuria is considered to be an early stage of diabetic nephropathy as well as a marker of cardiovascular disease. The aim of this study was to see the prevalence of microalbuminuria in type 2 diabetic patients and assess its association with cardiovascular risk factors among them. A total of 143 type 2 diabetic patients with the mean age of 56.06 +/- 1.08 years were analysed. The prevalence of microalbuminuria and overt proteinuria was 45.5% and 11.2%, respectively. Prevalence of microalbuminuria in female was marginally higher than in male (p > 0.05). Subjects with microalbuminuria had significantly higher blood pressure (p < 0.001) and duration of diabetes (p < 0.05) compared with normoalbuminuric subjects. High density lipoprotein was found to be significantly lower (p < 0.05) in subjects with microalbuminuria whereas fasting blood sugar, triglyceride, total cholesterol and very low density lipoprotein were marginally higher in microalbuminuric than in normoalbuminuric subjects (p > 0.05). High prevalence of microalbuminuria in diabetic patients and its positive association with blood pressure and altered lipid profile suggests that screening for microalbuminuria is essential for intervention and prevent further complications like end stage renal disease and cardiovascular diseases.