Wide local resection of sacral chordoma through posterior midline approach

This study was performed in 21 patients with sacral chordoma from July 2008 to June 2017 and posterior surgical approach was used for resection. Out of 21 patients, 12 had done subtotal sacrectomy and the remaining 9 had done partial sacrectomy. Their follow-up periods were at least five years. Operative time ranged between two to four hours. All patients recovered well from operation and two to five units of blood transfusion were needed for each. After operation, majority of the patients developed some bowel and bladder dysfunction and five patients developed wound infection. During the follow-up, two patients had tumor recurrence and one patient expired two years after operation. The remaining 18 patients were tumor-free at the 5-years follow-up. Wide surgical resection via the posterior midline approach could be a good management plan for the sacral chordoma. However, complete removal with surgical margin varies according to the location of the tumor

Perception of rotating interns on emergency medicine posting of undergraduate curriculum and future career

Introductions: Competency in basic knowledge and skill of emergency care is the fundamental goal of all the medical graduates irrespective of their specialty. The aim of this study is to understand the view of young doctors regarding the importance of emergency medicine (EM) both during internship and undergraduate MBBS curriculum. Methods: This was a descriptive cross sectional study conducted at emergency department, KIST Medical College, Lalitpur, Nepal, during 2016 to 2017. Interns were asked to fill up preformed questionnaires to explore the effectiveness of the posting and its necessity to integrate in undergraduate medical education. Results: All the respondent medical interns accepted emergency medicine posting was fruitful. Ninety-six (62.3%) thought one month Emergency Department (ED) posting as appropriate. All the participants thought EM should be included in the undergraduate curriculum (UG). Majority believed it would be appropriate in third year (42%) and final year (42%). One hundred and thirteen (73.4%) wanted to pursue emergency medicine career however 41 (26.6%) were reluctant. Conclusions:  All the interns surveyed accepted emergency medicine to be fruitful and should be included in the undergraduate curriculum with one month emergency department posting, and two thirds wanted to pursue it as future career. Keywords: emergency department posting, emergency medicine, perception of interns, undergraduate medical curriculu

Coccygectomy can be a option for coccydynia which is refractory to medical treatment

The aim of this study was to evaluate the clinical outcome of coccygectomy those who were refractory to conservative treatment. Twenty patients (5 males, 15 females) underwent total coccygectomy when coccygodynia did not responding to medical treatment July 2013 to September 2018. All the patients timely attended with non-traumatic (n = 12) and traumatic (n = 8) cause with mean follow-up visits of 24 months (range 18-28 months). The outcome pain intensity was evaluated by visual analogue scale (VAS) in sitting position and during daily activities. Three patients had infection which improved after antibiotic therapy. The VAS improved from 6.4 ± 0.9 to 2.1 ± 0.9 for sitting and from 5.8 ± 0.9 to 1.6 ± 0.6 for daily activities. Improvement in pain and daily activities were significant at the final follow-up. Ninety percent patients were satisfied with the operation

Bacteriological Etiology and Antibiotics Susceptibility Pattern in Blood Samples from the Patients Attending Emergency Department of a Tertiary Care Hospital, Nepal

Background: Bacteriological aetiology and its culture sensitivity pattern is an important parameter for evaluating antibiotic use in Emergency Department. Blood-stream infections cause significant morbidity and mortality, increase in length of hospital stay and increased cost of care. Frequent inappropriate antibiotic use contributes to emergence of drug-resistant bacteria pathogens. Objectives: The objective of this study was to identify likely etiologic agents’ and antibiotic sensitivity profile of bacteria from blood stream infection in Emergency Department of Patan Hospital. Methodology: The study was conducted at tertiary care hospital from July to August 2014  blood culture was done and  antibiotic susceptibility test was performed following Kirby Bauer disc diffusion technique and growth and sensitivity pattern of organisms isolated were analyzed.   Results: There were 282 blood culture sent from the Emergency Department. The most common bacterial isolates were Enterobacter species. Second most common bacteria were Streptococcus pneumoniae.  Enterobacter species was more sensitive to Chloramphenicol, Amikacin and Gentamycin. While Streptococcus pneumoniae was sensitive to most of the antibiotics, we also found that 65.3% bacterial isolates were resistant to Cephalosporin. Conclusion:  Contaminated blood samples were found higher therefore, emphasis should be given in reducing the contamination. Proper cleaning of skin with antiseptic and guidelines to draw blood for culture should be familiarized and strictly followed while drawing the blood and others from Emergency Department of Patan Hospital.  

Influence of feed source on determination of fat and protein in milk by near-infrared spectroscopy

,\ bstract R~.;el v~d 9 September 1998: accepted 10 April 1999 \ !v[lIk s ample~ fr om two experiments (II = 506 in tOlal) were an ,dyzed by measurement of near-infrared (NIR) spectra to investigate the etlect of feed source on milk fat and prolein content. ivlilk samples from the lirst experiment (n = 3uO) were used for development of the calibration equation and validation of the equation. The calibratlon equatIOns thus developed in the first experiment were then used in the second experiment to ~xamine the applications of NIR measurement. All feeding trials used the same basal rations, which conSisted of corn silage, [talian ryegrass, Alfalfa haycube, corn Rake and commercial concentrate. The first experiment was comprised of three rations: (I) basal ration , (2) basal ration with soy bean meal (48% of total crude protein (CP)) and (3) basal ration with soybean meal (19% of total CP) and fish meal (25% of total CP) The second experiment was comprised of five supplement alternatives (I) no supplement (NS), (2) corn g~uten meal (CGM, 26% of total CP), (3) nsh meal (FM, 26% of total CP), (4) defatted soybean meal (SSM , 28% of total CP\ and (5) roasted soybean meal (RSBM, 26% of total CPl. Feeding regimes in both experiments were adjusted to fulfill the maintenance and production requirements. The results showed that NIR prediction of milk fat content was not influenced by the feed of animal$. while the accuracy of protein prediction was significantly affected by the kind orreedstuff used in the ration . Thus, a wide range of milk sample~ from cows 0 11 ~ Iearl y defined feeding regimes is necessary for developing a satisfactory calibration for NIR systems. © [999 Elsevier Science Ltd . Ali rights reserved. Keywords .· NIP. analysis; Milk fal; Milk pro tein : }·eed supplemenl atio

Milk Nitrogenous Components as Measured by Near Infrared Spectroscopy-study on the repeatability for Predicting Different Population Samples

The study on the use of near infrared reflectance spectroscopy (NIRS) analysis for measuring milk nitrogenous components (crude protein, true protein, casein and milk urea nitrogen (MUN)) was carried out using one hundred seventy milk samples collected from lactating Holstein cows used in three feeding experiments. Experiment 1 consisted of ninety-six milk samples using sixteen mid-lactation cows fed a basal ration containing corn silage, Italian ryegrass wafer, Alfalfa haycube, corn flake and commercial concentrate with four kinds of supplementation, (I) corn gluten meal (CGM), (2) fish meal (FM), (3) roasted soybean meal (RSBM) , and (4) defatted soybean meal (SBM) for each four animals. Experiment 2 consisted of forty-two milk samples from seven early lactation cows raised under total mixed ration (TMR) feeding management containing corn silage, Timothy hay and concentrate. Experiment 3 consisted of thirty-two milk samples from eight early lactation cows raised under two rations feeding management, (I) basal ration supplemented with SBM, and (2) basal ration supplemented with mixed of SBM and FM. Basal ration in this experiment was similar with that given in experiment l. The samples from experiment I and 2 were randomly separated into two groups, (1) calibration set samples (n = 84), (2) validation set samples (n = 54), while the milk samples from experiment 3 were grouped as (3) application set samples. These groups were used for developing calibration equations, validating the equations, and for evaluating the reproducibility when the calibration equations were employed to samples from different population. Using four combinations of wavelengths at 1650, 1698, 1738 and 1756 nm, the accuracy and reproducibility of measurements were high for crude protein, true protein and casein, but not for MUN. Animal Science Journal 70 (5) : 343-348, 1999 Key words: NIRS, Milk nitrogen components, MU