Etiology, Pattern, Treatment and Outcome of Maxillofacial Fractures at Dhulikhel Hospital.

Background Maxillo-Facial region is one of the prominent parts of human body and is more vulnerable to injury when any form of trauma is encountered. Injury to this region can result in fractures and pattern of fractures often depends upon the mechanism of injury as well as direction of impact. Objective To determine the etiology, pattern, treatment, and outcome of maxillofacial fractures presenting to Dhulikhel hospital. Method The records of all the patients with maxillofacial injuries presenting to the department of oral and maxillofacial surgery of dhulikhel hospital between period of December 2012 to November 2019 were included in the study. The data regarding age, sex and etiology were recorded. The etiologies were classified as Motor vehicle accidents (MVA), interpersonal violence, fall injuries, sports related injuries, occupational hazards, gunshot injuries and animal attacks and others. Similarly, the pattern of fractures was recorded according to classification by anatomical site. The types of treatment performed was also recorded. Treatment outcome in the form of any postoperative complications were recorded. Result Out of 1366 patients with maxillofacial injuries, 378(27.7%) patients had fracture of maxillofacial region. The most common etiology was motor vehicle accidents (53.7%) followed by fall injury (31.2%). Zygomatico-maxillary complex was the most common type of fracture (27.9%). Open reduction and internal fixation were the most common form of treatment provided (85.4%) and post-operative complications were minimal (5.0%). Conclusion Motor vehicle accidents still remain the most common cause of maxillofacial fractures. Midface fractures are more common than mandible fracture. The present study provides an insight into changing etiology and pattern of maxillofacial fractures and open reduction and internal fixation remains the most favored treatment of maxillofacial fractures with minimum complications.

Clinicopathological Analysis of Oral Lesions - A hospital based retrospective study.

Background Proper diagnosis plays a key role that determines treatment and prognosis of the disease. To give appropriate clinical diagnosis, clinicians must be well aware of the presentation and demographic information of the lesion including the rare ones. Histopathology is still considered as gold standard in diagnostic pathology but final diagnosis becomes difficult unless detailed clinical and radiological descriptions are given. Hence an interdisciplinary approach is needed which requires correlation between both clinical and pathological details. Objective To analyze the clinicopathological details of all the oral lesions diagnosed in Dhulikhel hospital within the period of two years and to assess the concordance between clinical and histopathological diagnosis of these lesions. Method Laboratory record file of all the oral lesions diagnosed between January 2016 to December 2017 were retrieved from the department archives and the data were collected. The extracted data were analyzed using SPSS version 23.0. Result A total of 237 cases were analysed in the present study. Odontogenic cysts were the most common category followed by benign lesions. However considering the individual lesion, mucocele was the commonest lesion followed by squamous cell carcinoma. Total concordance between clinical and histopathologic diagnosis was found in 56.5% cases. The most clinicopathological agreement was seen for benign lesions followed by malignant lesions. Conclusion Mucocele and oral squamous cell carcinoma are the two most common lesions found among the patients visiting our hospital. The cases of oral squamous cell carcinoma are on a rise with each subsequent year. At present, though it is the second most common entity, it can be hypothesized that it may be higher up on the list. Therefore, oral healthcare awareness is paramount and this may be one of the best ways to reduce the oral cancer incidence rates and lowering the healthcare management burden.

Juvenile Ossifying Fibroma of Maxilla.

Ossifying fibroma (OF) is a rare, benign, non-odontogenic tumor of the jaw which comes under the group of fibro-osseous lesions. Ossifying fibromas of the mandible are more common than in the maxillary region. Juvenile ossifying fibroma has been distinguished from conventional ossifying fibroma on the basis of patient's age, site predilection, and clinical behavior. The lesion should be differentiated from other fibro-osseous lesions as its management varies from surgical enucleation to complete resection. Present report describes the case of juvenile ossifying fibroma of anterior maxillary region in a 7 year old male patient, with a detailed description of clinical, radiographic, histopathologic features, and its surgical management.

Acceptability and Reliability of the Bayley Scales of Infant Development III Cognitive and Motor Scales among Children in Makwanpur.

BACKGROUND: The Bayley Scales of Infant Development III (BSID III) is an instrument to measure the development of children aged 1-42 months. Our study sought to assess the feasibility and reliability of the BSID III's cognitive and motor sub-scales among children in rural Nepal. METHODS: For this study, translation and back translation in Nepali and English for cognitive and motor sub-scale of BSID III were done. Two testers assessed a total of 102 children aged 1-42 months and were video-recorded and rescored by the third tester. Raw scores were calculated for each assessment. Inter and intra-observer reliability of scores across the three testers was examined. Raw score was converted into scaled score to examine the mean score. The study received ethical clearance from NHRC. RESULTS: A total of 102 children were assessed. The inter-rater reliability of the BSID III among three testers using the Intraclass Correlation Coefficient by age group was 0.997 (95% CI: 0.996-0.998) for the cognitive scale, 0.997 (95% CI: 0.996- 0.998) for the gross motor scale, and 0.998 (95% CI: 0.997- 0.999) for the fine motor scale. All were statistically significant (p< 0.0001). The mean scaled cognitive, fine motor and gross motor development scores in this group of children were 8.3 (SD: 2.5), 8.5 (SD: 2.6) and 9.5 (3.2), respectively. CONCLUSIONS: Assessing the cognitive and motor development of children under five using the BSID III was feasible in Makwanpur district, Nepal. The inter-rater reliability was highly comparable among the three testers.

Value of sputum differential count in chronic obstructive airway disease.

BACKGROUND: Sputum differential count is a useful tool to evaluate airway inflammation in chronic airway diseases. Since COPD (chronic obstructive airway disease) is so common in our setting this simple tool can be used to initiate and follow up treatment and progression of disease process. METHODS: A prospective cross sectional study was done in Department of Medicine, in a Teaching Hospital from June 2011 to June 2012. All patients admitted with acute exacerbation of chronic airway disease to the Department of Medicine were included in the study and their sputum was sent for differential count. RESULTS: Predominant cause of chronic airway disease was COPD 61 (85.9%). The sputum of these patients predominantly showed neutrophilia in the differential count with a mean neutrophil count of 82.06%. This was significantly high than the stated 60% in stable COPD. None of the COPD patients had eosinophilia or lymphocytosis. One patient with asthma showed eosinophil count of 12%. In these patients the peripheral blood smear differential did not show correlation with sputum neutrophilia (r2≥002, p≥0.05). CONCLUSIONS: Sputum differential has an important role in management of chronic airway diseases.

Prevalence of blindness and visual impairment and its causes among people aged 50 years and above in Karnali Zone, Nepal.

OBJECTIVE: To estimate the prevalence of blindness and visual impairment and its causes among those aged 50 years and above in Karnali Zone. MATERIALS AND METHODS: Stratified cluster sampling method was used. Twenty four clusters of 50 people aged 50 years and above were selected for the study. Visual acuity was recorded with simplified vision testing card with one optotype "E" of size 60 on one side and size 18 on the other side. Examination by ophthalmologist under mydriasis was done for those with a pinhole visual acuity of less than 6/18. RESULTS: Of 1200 enumerated persons 1,174 were examined (97.8% response rate). The prevalence of blindness (VA less than 3/60 in better eye) with available correction was 3.4% (40), (95% CI=2.36-4.44); 2.3% (15) for male and 4.8% (25) for female; with best correction it was 1.6% (19), (95% CI=0.9-2.34), 1.1% (7) for male and 2.3% (12) for female. Untreated cataract was the cause of blindness in 67.5%. Severe visual impairment (less than 6/60 - 3/60 BCVA in better eye) was seen in 2.1% (1.1% male and 3.4% female). Refractive error was the cause of visual impairment in 36.8% and untreated cataract in 58.8%. CONCLUSION: Cataract and refractive error are the commonest cause of blindness and visual impairment. Females are 3 times more prone to blindness than their male counterpart. Accessible and equitable services are necessary for blindness prevention.

Prevalence and correction of near vision impairment at Kaski, Nepal.

INTRODUCTION: Presbyopia is an important cause of avoidable visual disability. OBJECTIVE: To estimate the prevalence of near vision impairment and spectacle coverage among middle and older-aged adults in rural Nepal. MATERIALS AND METHODS: The surveys was carried out among the people of age 35 and over in randomly-selected cluster samples in rural settings of Kaski district of western Nepal, Near visual acuity, with and without presenting near correction, was measured at 40 cm using a LogMAR near vision tumbling E chart under ambient indoor lighting. Subjects with uncorrected binocular distance vision of 20/40 or worse were refracted and those with near vision of 20/40 or worse tested with plus sphere to obtain the best-corrected binocular near visual acuity. RESULTS: A total of 2,360 persons aged 35 years and over were enumerated and 2,156 (91.3%) were examined. The age- and gender-standardized prevalence of uncorrected near visual impairment (vision of 20/40 or worse) in study population was found to be 66.1 %. Near vision could not be corrected (>20/40) even after distance and near vision correction in 6.4 % . Using the multiple logistic regression models, uncorrected visual impairment was associated with an older age (odds ratio [OR] = 1.13, P less than 0.001) and a lower educational level (OR = 1.11, P = 0.01) was less associated with female gender (OR = 0.72, P = 0.038). Over 90 % of people with near visual impairment did not have spectacles. CONCLUSION: The prevalence of presbyopia appears to be higher with an earlier onset and over 90 % of people in need of near correction do not have spectacles in this setting.

Profile of pediatric ocular trauma in mid western hilly region of Nepal.

INTRODUCTION: Majority of blinding ocular injuries can be prevented. OBJECTIVE: To describe the epidemiology of ocular trauma in children. MATERIAL AND METHODS: A retrospective review of medical records of the patients aged below 16 years who attended the Himalaya Eye Hospital, Pokhara with history of ocular injury. RESULTS: Of 6,829 pediatric patients, 554 (8.1 %) had ocular trauma. The ocular trauma was more prevalent (38.1 %) in the age group of 5 - 10 years followed by 10-15 years (16.6 %). The boys (62 % vs 38 %) were more prone to ocular trauma than girls (RR = 1.7 and 95 % CI = 1.41 - 2.02). Of 554 ocular injuries, 32 (5.8 %) were open globe injuries. Sub-conjunctival hemorrhage was the commonest presenting finding in 96 (17.3 %) subjects. Forty-seven (8.5 %) of them attended the hospital after 15 days of injury. Home was the most common place for trauma (n =204, 36.8%), followed by playground (n = 140, 25.3 %). CONCLUSION: Children between the ages of 5-10 years are most vulnerable to ocular trauma.Home is the commonest place for ocular injury followed by playground. By adopting some common safety factors or by reducing the ocular injury risks factor, ocular trauma can be greatly reduced.

Pseudoexfoliation syndrome in various ethnic population of Nepal.

Pseudoexfoliation syndrome is an ocular condition characterized by a distinctive deposition of fibrillar material in the anterior segment of the eye. Pseudoexfoliation syndrome is frequently associated with glaucoma. Though it is seen in all the population, prevalence varies considerably in different races. A hospital based study done in Nepal by our group showed that Gurung population is frequently affected by this disease than any others. To determine the fact a larger population based study was necessary. Thus a research was designed to survey the various populations in the community. Different population from Kathmandu valley, Kavrepalanchowk, Pokhara, and Ghandruk were evaluated in two different phases to include major ethnic population living in Nepal. Household surveys done to bring all the targeted population to base hospital and detail examination including anterior segment evaluation after dilatation of pupil, optic disc evaluation, intraocular pressure measurement, gonioscopy, visual field recording and photographic documentation was done. Total of4430 population surveyed while only 2135 fulfilled the criteria for inclusion. Gurungs irrespective of their place of residence showed higher prevalence of Pseudoexfoliation syndrome accounting for 7.8% in Kathmandu valley while 12.0% in Ghandruk. Tamangs were affected very rarely by this disease accounting only for 0.3%. Gurungs are at higher risk of developing Pseudoexfoliation syndrome than any others in Nepal.

Prevalence of blindness and cataract surgery in Gandaki Zone, Nepal.

BACKGROUND/AIM: Himalaya Eye Hospital (HEH), established in 1993, is rendering eye care services in the Gandaki and Dhaulagiri zones. The hospital has extensive community outreach activities along with services for outpatients, emergencies, and subspecialties such as vitreoretinal, paediatric, and low vision. The operation theatre is well equipped to match the surgical needs including phaco surgery for cataract. The hospital has performed more than 14 000 cataract surgeries and 250 000 treatment services during this period. The aim of this study was to estimate the prevalence of blindness, visual impairment, and cataract surgical coverage among the older adult population of three districts of Gandaki Zone, where 80% of the hospital's service recipients reside. METHODS: People aged 45 years and older were enrolled in the study using a stratified cluster design. Subjects in 25 randomly selected clusters from the listed 806 were recruited through door to door visits. Each recruited subject had visual acuity (VA) and clinical examination conducted by an ophthalmologist. The survey was preceded by pre-pilot and pilot studies to refine the operational method. To assess quality assurance the interobserver variation in VA measurement was also carried out in five different clusters. RESULTS: Out of 5863 selected subjects 85.3% were examined. Blindness defined as presenting VA <6/60 in both eyes was found in 2.6% (95% confidence interval (CI): 2.2 to 3.9), whereas 16.8% individuals examined had vision <6/19 in one or both eyes. Cataract was the principal cause of blindness in 60.5%, and refractive error was the dominant cause of vision impairment (<6/19) 83.3%. Cataract surgical coverage was 59.5% among the cataract blind and associated with younger age, literacy, and male sex. CONCLUSION: The finding suggests a positive impact of the HEH programme on the prevalence of blindness and cataract surgical services in the survey area. Strategies to further improve access and utilisation of facilities and increase cataract surgical coverage need to be developed.

Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal.

PURPOSE: To study the epidemiology of chronic dacryocystitis and the success rate of external dacryocystorhinostomy (DCR) in Nepal. PATIENTS AND METHODS: This is a retrospective descriptive and interventional case series. A total of 662 records of patients with chronic dacryocystitis due to nasolacrimal duct obstruction, who were treated by means of external DCR without bicanalicular silastic tube intubation, were studied. STATISTICS: Mean for age with standard deviation and confidence intervals were calculated. The significance of the difference in means was calculated using the unpaired t-test. RESULTS: Of 662 patients, 67.6% were female. The mean age of the patients was 27.4 +/- 13.7 years (SE = 0.53, 95% CI = 26.34-28.46). Chronic dacryocystitis due to nasolacrimal duct obstruction was found in 86 patients (13.0%) from the high hills (mean age = 35.3 +/- 11.4 years, 95% CI = 32.85-37.75), but most patients (576, 87.0%) were from the subtropical lowlands with a monsoon climate (mean age = 26.9 +/- 13.3 years, 95% CI = 25.8-28.0; p = < 0.01). An overall success rate of 88.6% (89.8% for high-hill patients and 87.4% for those from the lowlands) was obtained after DCR. CONCLUSION: Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.

Barriers to up take cataract surgery in Gandaki Zone, Nepal.

OBJECTIVE: Cataract though avoidable remains as leading cause of blindness in Nepal. Though, Himalaya Eye Hospital rendering high quality surgical service through its base hospital and out reach service in Gandaki Zone having cataract surgical rate is below 1500 per million. Therefore, it is mater of interest to investigate the reason and the finding would be helpful to plan the future cataract programme to CSR to desirable level, if we know the reason(s) that forced them living as blind in community and not seeking available surgical services. METHOD: All person with cataract affecting their visual acuity to <6/60 (corrected) in either eye found in stratified cluster design sampling were enrolled in the study. They were interviewed with structured questionnaire investigating their knowledge and attitude of their visual impairment and barriers for not seeking cataract surgical service to date. RESULTS: A total of 303 eligible subjects were enrolled in the study. Out of them 57.8% of people knew about the cataract and they also think their vision impairment is due to cataract. But 56.11% of people were not aware their vision will improve. Surgical camp attendant or operated patients were found to be effective media to spread the message that the cataract is curable. Among the barriers: fear for surgery 31.1%, lack of attendant and geographical distance 32.8%, financial 24.1% and other clinical reason were found to be 12% as a reason for not seeking available surgical service. CONCLUSION: The cataract service marketing, eye health education disseminating the information on cataract and its curability is not found to be adequate. Therefore, the future cataract programme should give more concentration on creating awareness on cataract and subsidizing the available surgical service and service need to be brought to more proximity for the needy poor people.

Serum level of low-density lipoprotein cholesterol in hypertensive retinopathy.

Increased serum level of low-density lipoprotein is associated with coronary artery disease. There are, however, no reports on whether the same is true in hypertensive retinopathy. A cross-sectional comparative study was carried out to evaluate the serum level status of low-density lipoprotein in hypertensive retinopathy, including 30 randomly selected subjects with hypertensive retinopathy; age and gender matched 26 hypertensives without fundus changes. Serum low-density lipoprotein cholesterol (LDL-C) levels were assessed in all subjects. Results showed statistically significant (p < 0.0196) higher serum levels of LDL-C in hypertensive patients with retinopathy (mean +/- SD = 2.45 +/- 1.76 mmol/l, SE = 0.33 and 95% CI = 1.79-3.11 vs mean +/- SD = 1.6 +/- 0.4 mmol/l, SE = 0.08 and 95% CI = 1.44-1.76). An increased serum level of LDL-C is associated with hypertensive retinopathy.