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The article presents a study which analyzes the soil-borne Fungi of Cultivated Lands in Biratnagar, Morang District, Nepal. It analyzes the diverse types of pathogenic and non-pathogenic fungi and examines the factors that contribute in the distribution and growth of soil fungi. It gathers soil samples randomly in Biratnagar for the cultivation of micro-organisms wherein it also examines the relation of soil borne fungi with depth, soil Ph, and soil texture to analyze the development and sporulation of soil fungi The result shows that soil texture, temperature, and organic and inorganic nutrients are the various factors that largely contribute in the distribution and growth of soil borne fungi.

Introduction: Mandibular third molar impaction is the most common impaction as third molars are last to erupt at the age of 17-25 years. Despite its high prevalence and negative impacts, there is limited study about mandibular third molar impaction. The aim of this study is to find out the prevalence of mandibular third molar impaction among patients visiting the outpatient Dental Department of a tertiary care centre., Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Dental Department of a tertiary care centre from 1 January 2023 to 30 June 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. A total of 414 orthopantomograms were prospectively reviewed for the angulation of impaction, depth and position. The indication for extraction was recorded from patients' cards during the time of extraction. Convenience sampling method was used. The point estimate at a 95% confidence interval was calculated., Results: The prevalence of mandibular third molar impaction was 37.13% (34.29-39.97, 95% Confidence Interval). There was a high prevalence of mesioangular 344 (45.38%) pattern followed by vertical 249 (32.85%) for mandibular third molar impaction, the most commonly involved group was 20-30 years, with female 247 (59.70%) predominance. Bilateral impaction 344 (83.10%) was more prevalent than unilateral. Depth A, 639 (84.3%), ramus relation level I, 602 (79.42%) was the most common level of impaction. Recurrent pericoronitis 160 (38.6%) was the common indication for extraction followed by dental caries 145 (35%)., Conclusions: The prevalence of mandibular third molar impaction was lower than other similar studies done in similar settings., Keywords: impacted tooth; pericoronitis; prevalence; third molar.

This viewpoint summarizes the discussion that occurred during the "Translating Policy to Practice in Telehealth-Lessons from Global Implementation Experiences" panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth., (©Oommen John, Suptendra Nath Sarbadhikari, Thanga Prabhu, Ashvini Goel, Alexander Thomas, Sunil Shroff, Fazilah Allaudin, Chaminda Weerabaddana, Dari Alhuwail, Udaya Koirala, Jayalal Johnrose, Patricia Codyre, Andy Bleaden, Shubnum Singh, Shuchin Bajaj. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 08.02.2022.)

Background: An impacted tooth is a tooth which does not reach the occlusal plane even after two-thirds root formation. Conditions associated with impacted teeth include trismus, cystic lesions, and cervical caries of second molars. The objective of this study was to evaluate the occurrence of carious lesions in the distal aspect of the mandibular second molar and its association with the presence of mandibular third molars., Methods: A cross-sectional study was conducted from September 2018 to September 2020. Approval was taken from the Institutional Review Committee with reference number 90/77/78. Orthopantomograms of patients aged 18 years or older were studied. Information on age, gender, mandibular second and third molars were recorded. Convenient sampling was done. Statistical analysis was done using Statistical Package for Social Sciences version 21., Results: A total of 626 radiographs were studied of which mesioangular impaction (35.3%) was the most prominent type and followed by horizontal impaction, causing distal caries in second molars. The age group between 20-40 years and female gender had the higher prevalence of distal caries in second molar teeth. There was a significant correlation between gender and cavity existence (p=0.00), between impaction and existence of decay (p=0.00), and depth of impaction with cavity formation (p=0.004)., Conclusions: A total of 31.8% of the patients with impacted mandibular third molars had distal cervical caries in second molars. Mesioangular type, female gender, type A were the prominent factors associated with distal caries in second molar teeth due to impacted third molars.

Introduction: The retromandibular transparotid approach provides the shortest and the most direct access to mandibular sub-condylar fractures. However, this approach is less preferred due to the fear of facial nerve injury. The aim of this study was to evaluate the safety and morbidity of the retromandibular transparotid approach for open reduction and internal fixation of sub-condylar mandibular fractures., Methods: A retrospective cohort study of 29 patients with 35 sub-condylar mandibular fractures who underwent open reduction and internal fixation through the retromandibular transparotid approach was conducted. The primary study variable was facial nerve palsy, whereas the secondary variables were infection, sialocele, salivary fistula, stability of the fractured segments, post-operative malocclusion, Frey's syndrome, and unesthetic scar. All patients were followed up for 6 months. Predictor variables included age, gender, side, location, displacement, etiology, concomitant maxillofacial fractures, and healing status. Fisher's exact test was calculated to find the association between primary variables and predictor variables., Result: Out of 35 sub-condylar fractures (29 patients; 23 male, 6 female), four (11.42%) developed transient facial nerve palsy. Fractures at the condylar neck level (P = .045) and with displacement (P = .026) were significantly associated with the development of facial nerve palsy. Four patients (13.8%) developed slight malocclusion, two had surgical site infections, two developed sialoceles, and one had a salivary fistula., Conclusion: The retromandibular transparotid approach is safe and effective with rare major complications in the management of sub-condylar fractures of the mandible. Condylar neck fractures and displaced fractured segments are associated with an increased risk of development of facial nerve palsy., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: To review our early experience to determine the feasibility, efficacy and clinical outcomes of retroperitoneoscopic surgery in benign renal diseases., Methods: This is a prospective observational study carried out between December 2014 to March 2018. Among 14 patients enrolled in the study, 9 cases of nonfunctioning kidney underwent retroperitoneoscopic simple nephrectony, 4 cases of benign renal cortical cysts underwent decortication of cysts and one case of pelviureteric junction obstruction underwent Anderson Hynes pyeloplasty., Results: Retroperitoneoscopic nephrectomy, renal cyst decortication and A-H pyeloplasty were performed in 13 patients successfully. The procedure in one patient of RP nephrectomy converted to open surgery due to dense perinephric and hilar adhesions. Which resulted to failure to progress. The mean operative time of RP nephrectomy, decortications and pyeloplasty were 206.4 (150-248), 67.5 (60-80) and 275 minutes, average blood loss was 96.7 (50-120), 27.5 (20-30) and 70 ml, and the mean hospital stay were 3.5 (3-4), 2 (2-2) and 4 days respectively. The perioperative period was uneventful., Conclusions: Retroperitoneoscopic surgery is feasible and safe in benign renal diseases. Because of reduced post operative pain and less chances of bowel injury, retroperitoneoscopic surgery is gaining more popularity.

Background: The gold standard of quick and definitive treatment of Abdominal compartment syndrome (ACS) is surgical decompression by opening the abdomen and leaving it open until intra-abdominal pressure decreases. Temporary abdominal closure techniques are used to postpone definite closure until predisposing factors causing pathologic elevation of intra-abdominal pressure are resolved.This study aim to analyze feasibility of Bogota Bag placement as a way of temporary abdominal closure., Methods: Cases admitted in the period of eight years that were diagnosed to have or at risk to develop ACS and managed with 'Bogota Bag', irrespective of primary diagnosis were reviewed retrospectively. Cause of ACS, reasons to place Bogota bag, its complications and final outcome in terms of mortality related or not related with Bogota Bag placement were assessed., Results: Total of ten patients had placement of Bogota Bag in the period of eight years. Laparotomy for bowel perforation with peritonitis was the most common primary condition contributing to ACS. Bogota bag was placed in two cases after emergency decompression as a therapeutic measure whereas others were done as prophylactic measure. There were two mortalities (20%) which were not directly related to abdominal compartment syndrome., Conclusions: Abdomen closure with Bogota Bag for patients with ACS or likely to develop ACS is a feasible technique with minimal procedure related morbidities.

Introduction: Systemic inflammatory response syndrome symptoms immediately after surgery have lately been regarded as potential warnings of impending post-operative complications and multiple organ failure. This study was conducted to find out the clinical significance of systemic inflammatory response syndrome in postoperative patients and to investigate the relationship between the duration of post-operative systemic inflammatory response syndrome and the post-operative morbidity and mortality., Methods: Total 30 patients who received different gastrointestinal surgery and fulfilled the diagnostic criteria for systemic inflammatory response syndrome between 2006 and 2008 at Kathmandu Medical College Teaching Hospital were included. Patients were analyzed for preoperative physiologic status, surgical stress parameters, and postoperative status of systemic inflammatory response syndrome, complications, and end-organ dysfunction., Results: Duration of systemic inflammatory response syndrome or positive criteria's number of systemic inflammatory response syndrome after surgery significantly correlated with surgical stress parameters (blood loss/body weight and operation time). Septic complications and prolongation of systemic inflammatory response syndrome were associated with multiple organ dysfunction syndrome and increased mortality., Conclusions: Systemic inflammatory response syndrome is a useful criterion for the recognition of postoperative complications and end-organ dysfunctions. Early recovery from systemic inflammatory response syndrome may arrest the progression of organ dysfunction, thus reducing the mortality.

Background: Management of clinically negative lymph nodes (cN0) in primary lip squamous cell carcinoma (SCC) has always been a controversial topic., Methods: A systematic review of English-language electronic databases using Medline, Embase, Cochrane library, Google Scholar, SCI, and specific journals on the subject matter was done. Only the studies mentioning primary nonmetastatic lip SCC with cN0 neck treated by surgery only and having at least 2 years of follow-up data were selected. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analysis was followed., Results: The pooled estimate of occult metastasis in neck dissected specimen was 0.17 (95% confidence interval [CI], 0.10-0.28) and that of delayed nodal metastasis in patients without neck dissection was 0.08 (95% CI, 0.01-0.18)., Conclusion: The results do not prove sufficient to justify elective treatment of the neck in primary cN0 lip SCC and close observation would be a viable option in such cases. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1392-1400, 2015., (© 2014 Wiley Periodicals, Inc.)

Objective: To review the outcomes of three different methods of maxillomandibular advancement for the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS)., Methods: Twenty-four patients with severe OSAHS from January 2011 to January 2014 treated by three different methods of maxillomandibular advancement (MMA) and genioplasty, maxillomandibular advancement without rotation plus genioplasty, maxillomandibular advancement with counterclockwise rotation plus advancement genioplasty, maxillomandibular advancement with first premolars extraction and subapical osteotomy setback under general anesthesia were included in the study. Comparison of per-operative and post-operative cephalometric analysis, polysomnography (PSG), apnea and hypopea index (AHI), body mass index (BMI), average blood oxygen saturation (AOS), lowest oxygen saturation (LSaO2) and posterior airway space (PAS) data were performed. The operative time and post-surgical orthodontic treatment data were collected and analyzed., Results: According to Stanford criteria, the success rate of 100% was achieved with all the three methods. The difference between per-operative and post-operative AHI, AOS, SNPg and PAS were statistically significant (P<0.0001) for all the three methods. Significant difference was found between per-operative and post-operative SNA (81.51°±3.36° vs 88.17°±4.51°, P<0.0001), (82.25°±2.71° vs 86.54°±3.65°, P=0.0002) and SNB (72.37°±3.99° vs 80.59°±3.40°, P<0.0001), (73.65°±3.80° vs 81.37°±2.96°, P<0.0001) among MMA without rotation plus genioplasty and MMA with counterclockwise rotation and advancement genioplasty respectively. However, no significant difference was found between the pre-operative and post-operative SNA (82.18°±4.27° vs 84.19°±2.70°, P=0.2015) and SNB (73.28°±3.04° vs 75.35°±2.56°, P=0.2640) among MMA with first premolars extraction and subapical osteotomy setback. The average duration of postoperative orthodontics treatment was 8.3 months., Conclusions: MMA and advancement genioplasty is an effective surgical management for severe OSAHS. Cephalometric analysis and computer aided design are needed for personalized surgical methods. MMA without rotation and advancement genioplasty method leads to the protrusive skeletal deformity. MMA with counterclockwise rotation and advancement genioplasty method is effective in curing severe OSAHS with little effect on facial profile. MMA with first premolars extraction and subapical osteotomy requires longer operative time and longer postoperative orthodontic treatment.

Purpose: To review our experience regarding the difference in management and treatment outcomes of aggressive fibromatosis of the head and neck region in children and adults, emphasizing, in particular, the role of conservative surgery in comprehensive treatment strategies., Patients and Methods: A retrospective analysis of patients with aggressive fibromatosis was performed during a 5-year period (2008 to 2012). Nine patients were enrolled in the present study, including 5 children (age, <18 years) and 4 adults (age, >18 years). All patients underwent surgical intervention and were treated by surgical resection with different surgical margins. Adjuvant low-dose chemotherapy and radiotherapy were given to pediatric and adult patients, respectively, with macroscopically or microscopically positive surgical margins., Results: All 5 pediatric patients (3 females and 2 males) received low-dose chemotherapy after conservative surgical resection (in 4 patients, microscopically incomplete resection; and in 1 patient, macroscopic residual tumor). Of the 4 adults (3 females and 1 male), 2 underwent complete surgical resection and 2 underwent surgery and postoperative radiotherapy (1 patient had microscopically suspected residual tumor and 1 had macroscopic residual tumor). The patients were followed up for a period of 7 to 51 months. Two pediatric patients and one adult patient had disease progression after resection and became stable after continued adjuvant therapy. None of the patients had functional or cosmetic defects. All patients had good long-term outcomes, with no disease progression., Conclusions: For the treatment of aggressive fibromatosis, conservative resection with preservation of form and function should be given greater priority in all age groups. Also, postoperative adjuvant therapy is vital for patients with gross or microscopic residual tumor to obtain progression-free survival., (Copyright © 2014. Published by Elsevier Inc.)

Retroperitoneal hamartoma in adult is an extremely rare entity. Here we report a case of 23-years-old lady who presented with a large retroperitoneal mass and abdominal pain. The mass was surgically removed and the diagnosis of hamartoma was made on histological findings.

Background: The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. Bile leaks are the most common biliary complication of laparoscopic cholecystectomy., Methods: Total 530 patients who had undergone laparoscopic cholecystectomy from January 2004 to November 2006 at Kathmandu Medical College Teaching Hospital were studied for biliary complications after laparoscopic cholecystectomy., Results: We reviewed 500 laparoscopic cholecystectomies performed at our institution and found 13 cases of bile extravasation and/or biloma formation and/or bile duct injuries (prevalence, 2.6%). One bile duct transection was acutely recognized and treated with hepaticojejunostomy. Three lateral bile duct injuries were also acutely recognized, two of them were managed with primary repair of CBD without T tube and the other was managed with repair and T-tube drainage. Two patients had postoperative generalized biliary peritonitis, one of whom was undergone exploratory laparotomy and found to have lateral injury on CBD which was managed with repair and T-tube drainage, whereas the other was undergone diagnostic laparoscopy with clipping of duct of Lushka. Two patients presented within seven days with biloma, one was treated with percutaneous drainage alone, the other treated with percutanous drainage was found to be complete transection of CBD on subsequent ERCP and managed with late hepaticojejunostomy. One patient with continued bile leak from surgical drainage tube for more than one week was managed with ERCP, diagnosed to be bile leak from duct of Lushka, managed by sphincterotomy and bile duct stenting. One patient presented with obstructive jaundice 6 months after laparoscopic cholecystectomy was found to have Bismuth type II bile duct stricture and was undergone hepaticojejunostomy. The remaining three had bile leak from surgical drainage which resolved within one week without further complication., Conclusions: Laparoscopic cholecystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology.

Background: Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon., Methods: This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010., Results: 114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male., Conclusions: Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal.

Introduction: The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries. However, it has not been well accepted in our part of the world probably because of lack of infrastructures,established norms and published reports. We have analyzed the safety and feasibility of the procedure in the recently established first dedicated day care surgery centre of the country., Methods: All the patients with American society of anaesthesiologist (ASA) score I and II admitted for laparoscopic cholecystectomy are included. Operation are performed in the morning and closely observed till evening. Patients found to be medically fit to discharge; having a responsible person at home and who can make their own arrangements in case of problems were advised for discharge. Follow up was done by telephone call from next morning., Results: Total 35 patients underwent laparoscopic cholecystectomy. Age range was between 16-65 years and most of them were females (88%). Only 30 patients were operated in early morning and were eligible for day care surgery. 25 (83%) Patients were advised for discharge but only 10 (33%) could make arrangement. Other 15 patients could not go home mainly due to different psychosocial reasons. Only one patient needed readmission and Complications observed were minor and relatively few., Conclusions: Day care laparoscopic cholecystectomy is safe and feasible in our set up. Acceptance of the procedure is expected to increase once it is regularly practiced and awareness in improved.

Aims and Objectives: To study the impact the use of portable ultrasound can have for the benefit of the patients when used by doctors other than radiologist, in this case surgeons., Methods: Ultrasound performed by surgeons in the pre-operative, operative and post-operative period was studied. Patients presenting to the Hospital with acute abdomen was subjected to ultrasound. They were either pre-operative or post-operative patients. Five patients were scanned intraoperatively. The impact of these scans to the patients as well as the clinicians was studied., Results: This is an ongoing study and preliminary results of the scans show two pre-operative diagnosis of acute appendicular collection and one acute hydronephrosis. In the operation room, ultrasound was done on 5 cases. On three occasions, it was to locate renal stones so that it could be extracted with ease. On two of the case, it was t to confirm the adequacy of common bile duct exploration thereby allowing primary closure of the common bile duct. Post-operatively, it was used in four cases of which in two cases post-operative hemorrhage were detected timely within hours. In the other two cases, the surgical team was assured that the patient's complaint was not surgically related., Conclusion: Ultrasound should be an extension of the clinical examination when indicated and all clinicians should be proficient in its use in their respective fields.

Introduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated., Patients and Method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications., Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications., Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop.

One of the most difficult problem in reconstructive surgery is the replacement of lost bone from trauma, tumour, infection or congenital anomaly. This is a case report of a 20 year old male who had suffered a blast injury of his lower jaw. From his first admission in the Plastic unit of Bir Hospital on Feb 19, 2003, he had undergone multiple operations until Nov 2003. This is a description of a follow up surgery done in Kathmandu Medical College (KMC), Sinamangal. Difficulties encountered and options available have also been discussed.