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Introduction: The goal of this study was to see if the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) score was beneficial in determining the severity of COPD patients. It produces a score that reflects the impact of the condition on their health status. GOLD guideline (2013) recommends CAT above other respiratory questionnaires since it is regarded to be a better assessment tool. Methods: Cross-sectional study conducted in Karnali Academy of Health Sciences, Jumla (Nepal) who presented with COPD exacerbation. A validated CAT questionnaire in the local language (Nepali) was employed and completed by the patient, and then the total CAT score was calculated and grouped into four impact levels. Data was evaluated using descriptive statistics (such as percentage and mean) and Pearson’s correlation tests to compare means. Results: Out of 55 patients, 52.7% were females; all 55 had firewood exposure with current smoking history more prevalent in the high-impact group 0.5%. At 3 months, the median number of COPD exacerbations was 2 (range: 0–90) with median CAT score 30 (range: 17–37). Patients were divided into severity groups based on their CAT scores. 47.3% were in the high impact group, whereas none were in the low impact group. The “very high impact” group had a considerably higher median number of exacerbations than the other high impact and medium groups (5 vs. 2 and 0) respectively with p

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Background and Objectives: Pakistan Society for Rehabilitation of the Disabled Orthopedic Hospital is renowned for the correction of orthopedic deformities including foot and ankle deformities. Consultant orthopedic surgeon Afzal Hussain, pioneers the treatment of orthopedic deformities and has developed a new operative technique for congenital clubfoot. This research was planned to report the success of Hussain's Procedure in detecting and managing the anomalous structures. Material and Methods: This research was mixed retrospective and prospective research carried out during fellowship of first author in which, operative procedure of the resistant congenital clubfoot associated with anomalous structures viz. anomalous muscles and tarsal coalitions, were performed with the new operative procedure by Dr. Hussain, were assisted by the first author and a minimum of 5 years of follow up of the cases was done by the senior author (Afzal Hussain). Cumming’s modification of Laavag and Ponseti score was applied for the calculation of the results at the follow-ups. Results: During the fellowship, 10 cases of clubfeet with muscle anomalies were managed. Similarly 7 clubfeet with tarsal coalitions were managed. There was full correction of the clubfoot deformity. The cases were followed up by the senior author (Afzal Hussain) for at least 5 years. During the minimum of 5 years followup post completion of treatment, Cumming’s modification of Laavag and Ponseti scores of the operated clubfeet were found to be excellent. Conclusion: The resistance to management of congenital clubfoot by casting may be because of anomalous structures. New operative procedure by Consultant Afzal Hussain names as Hussain's Procedure was helpful in detecting and managing the anomalous structures.

Management of open Lisfranc injuries is challenging. The improper management of the injuries might lead to bad results like skin necrosis and arthritis of Lisfranc’s joints. A case of Myerson type A Gustilo Grade IIIB open Lisfranc injury was managed with single stage debridement and internal fixation. At three years follow-up, the result was excellent with American Orthopedic Foot and Ankle Society (AOFAS) midfoot score of 100 and the patient had rejoined his previous occupation requiring prolonged walking.

Bone graft harvesting is one of the common procedures in orthopaedics surgery, and iliac crest is the gold standard donor site for autologous bone graft. There are a number of complications related with harvesting iliac crest bone graft, "donor site pain" is the commonest one. We modified the conventional surgical technique for autogenous iliac crest bone graft on patients who underwent anterior cervical decompression/corpectomy and fusion surgeries. Among 23 patients, 18 didn't complain more pain at the donor site compared to the neck pain on the first postoperative day and the wound on the iliac crest did not affect their mobilisation. Mean Visual Analog Score was 2.62±1.80, 1.83±1.41, and 1.10±1.20 at the time of suture removal (14 days), at six weeks and three months respectively. At one year of follow-up, no patient complained of donor site pain. Our surgical modification has encouraging results and thus can be advocated for bone graft.bone grafting; complications; iliac crest; pain.

Baumann's angle and Lateral capitellohumeral angle measurements are essential to check the degree of reduction in supracondylar fracture of humerus in children. Although the normal values of the angles are available for other populations, there is lack of study in our population for these angles. The objective of the study was to find normal values of these angles in in Nepalese children and to compare the findings with studies done elsewhere.The study is a prospective observational study.conducted at Department of Orthopedics and Trauma Surgery, Tribhuvan University Teaching Hospital. The study was conducted from July 2019 to June 2020. A total of 56 participants were included. Baumann's angle and Lateral Capitellohumeral Angle were measured on Xrays.The mean(+/-SD) Lateral Capitellohumeral angle in our study was 48.4°(±3.40) The mean(+/-SD) Baumann's angle was 71° (±3.20). There was no significant difference in Lateral Capitellohumeral angle and Baumann's angle between different genders, age groups and right or left elbow.The measurements for elbow Baumann's and Lateral Capitellohumeral angles in our study were similar to other studies.

Introduction: Ganglion is a commonly encountered soft tissue tumor. Most commonly patients seek treatment for cosmetic issues. There are a variety of treatment options available but very few are effective and cosmetically acceptable. Common treatment techniques have either high recurrence rates or have complications. Treatment by transfixation with linen suture under local anaesthesia on an outpatient basis is an upcoming treatment. The objective of the study is to find out the prevalence of successful outcome of transfixation techniques in treatment of dorsal wrist ganglion. Methods: This study is a descriptive cross-sectional study undertaken at a tertiary care center from November 2018 to May 2020. Ethical approval was taken from the same institution. Convenient sampling method was used. Patients presenting with dorsal wrist ganglion and consenting for the transfixation underwent the procedure. All the patients were operated under local anesthesia. Statistical analysis was done using Statistical Package for Social Sciences version 24.0. Point estimate was done at 95% Confidence Interval and frequency and percentage were calculated. Results: Out of 30 cases, 29 (96.66%) have got successful outcomes with transfixation techniques. Among 30 patients, recurrences were seen in 2 (6.66%) cases. Patient satisfaction was high in 27 (90 %) cases. No complication was encountered. Conclusions: Transfixation technique had good results in terms of low recurrence rate, percentage resolution in size and high patient satisfaction.

Sebaceous horns are rare lesions that occur as conical projections in sun-exposed parts of the body. They are made of hyperkeratotic material and look like horns of the animals. They may har­bor benign, premalignant, and malignant lesions at their bases. We present a case of a 49-year-old lady who presented with a conical growth at the operative scar of minimally invasive open lumbar discectomy. Excision of the horn along with the base was done, and the histopathology revealed benign seborrheic keratosis, suggesting sebaceous horn.

Introduction: Idiopathic Adolescent Scoliosis (IAS) is the commonest type of scoliosis without any known cause. There has been studies in different countries and population on IAS; and its prevalence rate varies for different population. There has been no reported study done in Nepal on prevalence of adolescent idiopathic scoliosis (AIS). The aim of this study was to detect and evaluate the prevalence of idiopathic adolescent scoliosis in school children in different parts of Nepal. Methods: This was a descriptive cross sectional study conducted at five schools from different geographical parts of Nepal, from January 2010 to December 2010. Scoliosis screening was done in 5 schools from different geographical locations of Nepal. Children (from grade 6 to 10; age more than 10 years) with positive Adam’s forward bending test and scoliometer angle of 5 degrees or more were subjected for radiographic evaluation of the spine. The criterion for the diagnosis of scoliosis was detection of Cobb’s angle of more than 10 degrees. Evaluation of scoliosis according to the age, gender, ethnic group, spinal region and magnitude of curve was done. Results: Out of 1094 children screened, 31 (2.83%) were referred for radiological evaluation; and 12 of them had lateral spinal curvature of more than 10 degrees. Hence the prevalence of scoliosis was 1.09%. The girl to boy ratio of distribution of scoliosis was 3:1 for larger curves of more than 20 degrees. Maximum number of scoliosis cases was seen in girls of 13 years, and the right sided thoracic scoliosis was most common. There is no ethnic predominance of scoliosis. Conclusion: Prevalence of idiopathic scoliosis among school children who need treatment in Nepal is low; however, school screening program has its epidemiological value. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9514 NOAJ July-December 2013, Vol 3, Issue 2, 14-19