Reconstructive microsurgery is challenging in Nepal and more generally in developing settings. However, persistent technical support such as training and workshops can make it feasible.

Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15th, 2017 to October 30th, 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.

Introduction: Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. In individuals with systemic hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, the effect of this transient sympathetic response can evoke life threatening conditions like pulmonary oedema, cardiac failure and cerebrovascular haemorrhage. Methods: Patients were randomly divided into two groups, 30 in each group. Group I received 50 mg of esmolol and group II received lignocaine 2 mg/kg. Haemodynamic parameters like pulse, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before induction of anaesthesia, immediately after intubation then at intervals of one minute, three minutes, five minutes, seven minutes and 10 minutes. Results: There was no significant difference in demographic or base line vital signs between two groups (Table 1). The mean systolic blood pressure increased on laryngoscopy and tracheal intubation by 15 mmHg in the group I whereas in group II it was 17.4 mmHg. There was a significant rise in diastolic blood pressure (DBP) in both the groups, but the rise was lesser in group II than in group I. Conclusion: Both esmolol and lignocaine were not effective in attenuating hemodynamic stress response to laryngoscopy and tracheal intubation; however esmolol was superior to lignocaine in blunting the stress response.  Keywords: esmolol; intubation; laryngoscopy; lignocaine; stress response.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Tonsillectomy is one of the most common surgical procedures performed worldwide by otorhinolaryngologists for the different indications. There are different studies in literature comparing bipolar diathermy with either harmonic scalpel or cold dissection but the thunderbeat is still not used in tonsillectomy. The thunderbeat device which is the integration of ultrasonic and advanced bipolar energies used exclusively in laparoscopic surgery but still not used in tonsillectomy. So, the main aim of this study is to compare the thunderbeat device with bipolar diathermy in surgical outcome of tonsillectomy</span>.</p><p class="abstract"><strong>Methods:</strong> This was the prospective study performed in total 25 patients. The patients included in the study underwent tonsillectomy on one side using thunderbeat device and on the other side using bipolar diathermy. The intra-operative blood loss, operative time and post-operative pain were taken for analysis in both the surgical procedures. <span lang="EN-IN">All the data were analyzed with the statistical package for the social sciences (SPSS) software version 20. </span><span lang="EN-IN"> </span></p><p class="abstract"><strong>Results:</strong> Among the twenty five patients, the age groups range from 19-36 years with mean age 25.36±5.62 years. Out of 25 patients, 7 were male and 18 were female. The comparison of operation time and intra-operative blood loss between thunderbeat and bipolar diathermy showed statistically significant differences. <span lang="EN-IN">The comparison of pain score showed statistically significant result with better pain results in bipolar diathermy</span>.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The thunderbeat uses in tonsillectomies is less time consuming and decrease intra-operative blood loss. But, the post-operative pain is more as compared to bipolar diathermy. Though, it is safe and effective in performing tonsillectomy but its cost is the main drawback for its regular use. </span></p>