Rapid spread of COVID-19 infection reached Nepal in about 1 month of its first appearance in China in December 2019 and affected all spheres of life and society including health and education, like in other countries. We are unprepared for this new menace with many unknown facts and uncertainties when well developed set ups with advanced science and technology also seemed drowned. We attempt here to appraise our situation (condition, trend) and reflect on to the lessons (observations, and messages) that we draw in various major areas of the activities of B. P. Koirala Institute of Health Sciences. We become acutely aware about the adverse effects of this pandemic in its academic, service and research activities along with all other aspects. Amidst the challenges, we were forced to take steps in scattered and trial and error pattern. This pandemic has brought our deficiencies in health system into surface and is offering opportunity to review, revise and reform them. We all the stakeholders, i.e. students, patients, clients, teachers, faculties, staff and authorities are in the same boat; all need to be in healthy, balanced and functional state for fruitful travel. We have certain weaknesses, drawbacks, deficits; and some strengths that we now should realize to move ahead in this COVID era.
Background: Irrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion e for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intraobserver reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard. Methods: This was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month. Results: The overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively. Conclusion:The S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones.
IntroductionThe rapid increase of COVID-19 cases since the beginning of May 2020, imposition of lockdown, and preparation activities to detect, manage and treat COVID-19 in public hospitals have impacted on the provision of non-COVID health care services resulting in increased morbidity and mortality in Nepal. This study aims to explore challenges in providing non-COVID as well as COVID-19 health care services through public hospitals in Eastern Nepal.MethodsA qualitative study with 25 key informants from three public hospitals in Eastern Nepal was conducted. Key informants were health care workers (HCWs) and managers of the hospitals. A thematic analysis was carried out to identify challenges in providing non-COVID and COVID-19 health care services.ResultsWe identified four themes: weak implementation; weak co-ordination and management; low accountability of HCWs and staff; and risk of infection and stigma as the challenges to provide COVID-19 health care services. We identified three themes: maintaining safety measures in hospitals, managing patients, and fear of infection as the challenges in provision of non-COVID health care services. Inadequate resources and HCWs, lengthy procurement process, and poor jobs specification were the main reasons for weak implementation. HCWs stated weak hospital administration while managers and focal persons complained of low accountability of HCWs and staff to manage COVID-19 health care services.ConclusionIn addition to inadequate resources; the risk of infection of COVID-19, maintaining safety measures in hospitals, ensuring clear leadership and governance, and preparing motivated and accountable HCWs and staff to get ‘work done’ are unique challenges observed in the study hospitals; and consequently need to be addressed.
Meralgia paraesthetica (MP) is a clinical syndrome produced by entrapment mono-neuropathy of lateral femoral cutaneous nerve (LFCN). It classically presents as numbness, paresthesia or dysesthesia of anterolateral aspect of thigh but sometime it may mimic conditions like lumbar radiculopathy, femoro-acetabular impingement, trochanteric bursitis, etc. Since it has wide spectrum of clinical presentation, it should be the diagnosis of exclusion when causes of anterolateral thigh pain is not explained by other known causes. The aim of this review is to provide an overview of this clinical condition with the emphasis on various clinical presentations and anatomical variations of the lateral femoral cutaneous nerve. Different methods of diagnosis and treatment are also explored and discussed in this paper.
Anterior dislocation of the elbow joint is a rare entity and is usually associated with injuries to surrounding bony and soft tissues. Simple dislocation of the joint is managed conservatively.An eight years old girl had traumatic anterior dislocation of the elbow joint with intact distal neurovascular status. X-rays showed no associated bony injury. Close reductions failed. Per operative findings showed no intra-articular fracture and the radial head was button holed into the anterior joint capsule. Reduction was achieved openly and maintained in a posterior slab for four weeks. Active and assisted mobilization started after removal of the slab. At ten month follow-up there was almost full range of movement of the joint._______________________________________________________________________________________Keywords: anterior dislocation; elbow; open reduction.
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