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Showing papers in "Nepal Medical College journal in 2019"


Journal ArticleDOI
KK Shrestha1, K Acharya1, RR Joshi1, S Maharjan1, Deepak Adhikari1 
TL;DR: Proper knowledge of both common and common sinonasal variations in the community could help in better surgical planning and overallmanagement of sinonAsal disorders.
Abstract: Computed tomography (CT) of the para-nasal sinuses (PNS) has nowadays become the investigationof choice for the diagnosis of sinonasal diseases. Numerous sinonasal anatomic variants exist and arefrequently seen on CT scans. A sound knowledge of these variations is important not only for diagnosisbut also for planning surgery in order to avoid complications. The aim of this study is to investigate thefrequency of these variations in patients with sinonasal symptoms and also to determine their relation tosinonasal disease if any. A total of 76 patients were included in the study from August 2017 to July 2018 ofwhich 43 (56.6%) were males and while 33 (43.4%) were females with male to female ratio of 1.3:1. The agesof patients ranged from 14 to 72 years with a mean age of 33.2±14.2 years. Out of 76 patients, 68 (89.5%)had at least one type of anatomical variation while 8 (10.5%) had no variation. Only one variation wasseen in 39 (51.3%) patients while 29 (38.2%) had two or more variations. The most common variant wasdeviated nasal septum (DNS), occurring in 49 (64.5%) patients followed by concha bullosa (CB) and aggernasi cell (AN) seen in 15 (19.7%) and 14 (18.4%) patients respectively. Genderwise, anatomical variationswere seen more in males but the difference was not statistically significant. Some variations were seenmore on the right sidewhile others on the left. Some variations were present bilaterally. The differencewas not statistically significant. The presence of DNS was statistically significant in the study population (pvalue 0.012 in nonparametric chi square test). The age group 14 to 30 years showed maximum variationsthough not significant statistically. Therefore, during management of patients with sinonasal symptoms,these variations need to be addressed, if required, surgically. Proper knowledge of both common anduncommon sinonasal variations in our community could help in better surgical planning and overallmanagement of sinonasal disorders Keywords : Anatomical variations, computedtomography (CT) scan, paranasalsinuses

10 citations


Journal ArticleDOI
TL;DR: It is strongly recommended to have animmediate educational intervention among the HCPs to improve the spontaneous ADR reporting and there was a weak positive correlation between knowledge and practice and also for attitude and practice.
Abstract: Pharmacovigilance (PV) is the science and activities related to the detection, assessment, understandingand prevention of adverse effects. Healthcare professionals (HCPs) have an important role in reportingAdverse Drug Reaction (ADR) cases. However under-reporting has been a major challenge in PV. Hence, weassessed the knowledge, attitude and practice (KAP) of HCPs about PV in a tertiary hospital of Kathmandu. Across-sectional study was conducted using pretested questionnaire consisting of 21 closed ended questions(twelve on knowledge, five on attitude, four on practice and one open ended question to know the causesof under-reporting. Out of 520 HCPs, 448 (207 doctors and 241 nurses) participated in the study with theresponse rate of 86.2%. The mean KAP score for doctors was 10.38 ± 2.68 and 9.60 ± 2.32 for nurses. Themajor barriers for under-reporting were identified as the difficulty in deciding if it’s an ADR and lack oftime to report ADRs. No significant correlation between knowledge and attitude of the HCPs was found(r=0, n=448, p< 0.01). However, there was a weak positive correlation between knowledge and practice (r=0.05, n=448, p< 0.01) and also for attitude and practice (r= 0.09, n=448, p< 0.01). Hence, the HCPs had poorknowledge and practice but positive attitude towards PV. It is therefore strongly recommended to have animmediate educational intervention among the HCPs to improve the spontaneous ADR reporting Keywords : Adverse drug reaction,attitude, knowledge, Nepal,pharmacovigilance, practice

9 citations


Journal ArticleDOI
TL;DR: The study revealed that among the adolescent girls of the study area, the overall menstrual hygiene practice was found to be poor and the various beliefs were found to been inappropriate and school absenteeism was also prevalent during menstrual cycle.
Abstract: Menstruation is a part of female reproductive cycle that starts when girls become sexually mature at the time of puberty. This study sought to assess the menstrual hygiene practice and school absenteeism among the rural school going adolescent girls. A descriptive cross-sectional study was done among 321 female high school students of 4 selected government schools of Kalikot a rural district of Nepal. It was found that majority of student’s menstrual hygiene practice was poor i.e. 86.9%. Majority of respondents (96 %) used clean cloth during their menstruation cycle, whereas only 4% of respondents used sanitary pad. Almost every adolescent girl i.e. 98.8 % practiced any cultural restriction. Nearly 1 in 4 respondents (22.1%) did not attend school during their last menstruation and more than 1 in 10 adolescent girls felt that their academic performance was degraded after menarche. Adolescent girls of 10-14 age group were three time more likely to have poor practice than those who were between 15-19 years. Adolescent girls from nuclear families are 1.9 times more likely to be absent from school during the menstrual cycle in comparison to girls from joint families. The study revealed that among the adolescent girls of the study area, the overall menstrual hygiene practice was found to be poor and the various beliefs were found to be inappropriate and school absenteeism was also prevalent during menstrual cycle.

6 citations


Journal ArticleDOI
A K Mishra1, V Adhikari1, P Chalise1, P Shrestha1, R P Singh1 
TL;DR: JESS fixator is cheap, easily available and less technically demanding, provides with an effective treatment for the metacarpal andphalanges fracture, as it provides adequate stability that allows early rehabilitation with soft tissue care and has got a good functional outcome.
Abstract: The fractures of metacarpal and phalanges of the hand are the most common injury encountered inemergency department. Most often these injuries are neglected as minor injuries and later on developsa functional limit of the hand. Joshi’s external stabilizing system (JESS) fixator based on the principleof ligamentotaxis, stabilize the unstable and intraarticular fractures of metacarpal and phalangeal andalso provides an environment for rapid soft tissue healing without further damaging the microvascularcirculation. The study includes total number of 38 patients with a diagnosis of fracture of Metacarpal andphalanx of hand admitted in Nepal Medical college and Teaching Hospital who were treated with JESSfixator. The functional outcome after the removal of JESS fixator was assessed by calculating AmericanSociety for Surgery of Hand and Total Active flexion (ASSH TAF). Among the 38 patients, all fractures wentto union with an average union period of 6 weeks. The mean period of treatment for metacarpal fractureswas12 weeks and for phalangeal fractures 16 weeks by which time patients regained full functional activityof hand and returned back to their respective works. The functional outcome assessed by ASSH-TAF scorewas excellent in 28 patients, good in 10 patients and none of them had a poor result. The complication wasseen in 9(23.68%) cases, superficial pin tract infection and K Wire Loosening. JESS fixator is cheap, easilyavailable and less technically demanding, provides with an effective treatment for the metacarpal andphalanges fracture, as it provides adequate stability that allows early rehabilitation with soft tissue careand has got a good functional outcome Keywords : American Society for Surgery ofHand and Total Active flexion(ASSH TAF), Fixator, Joshi’s externalstabilizing system (JESS), Metacarpaland Phalangeal fracture

6 citations


Journal ArticleDOI
TL;DR: The arteries supplying the kidneys show variation in the number, source and branching pattern which also include the presence of an accessory or additional and aberrant renal arteries.
Abstract: Each kidney is usually supplied by a single renal artery which is a lateral branch of abdominal aorta at the level of L1.The arteries supplying the kidneys show variation in the number, source and branching pattern which also include the presence of an accessory or additional and aberrant renal arteries. The additional renal artery towards the lower pole will cross the corresponding ureter and even cause ureteric obstruction. The segmental branches of renal and additional renal arteries are end arteries thus the accidental damage to these arteries can cause ischaemia or necrosis and other pathological conditions. The main objective of this study was to note the variations of the arteries supplying the kidneys. An observational study was conducted on thirty kidneys of fifteen cadavers which included the kidneys of both sides. The study was conducted in Department of Anatomy of Nepal Medical College Teaching Hospital during the period between July 2018 to June 2019 and the variations were recorded as (a) single main renal arteries were found in 80% specimens on both sides (b) early division of main renal arteries were found in 16.66 % on both sides (c) origin of main renal arteries were at higher level on left side in 16.66 % (d) presence of additional renal arteries were found in 20% on both sides. This study will be helpful to urosurgeons and also to radiologists performing various interventional radiological procedures. Department of Human Anatomy, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal.

5 citations


Journal ArticleDOI
TL;DR: High prevalence of hypothyroidism in this study necessitates universal screening of TD at first trimester of pregnancy, and Gestational hypertention, Pre-eclampsea and LSCS is significantly high in Hypothyroid pregnancy than euthyroid pregnancy.
Abstract: Thyroid disorders (TD) are the second most common endocrine disorders seen in pregnancy. Many physiological changes in pregnancy lead to hypothyroidism in pregnancy. Hypothyroid in pregnancy is associated with many adverse maternal and fetal outcomes. Objective of this study was to find the prevalence of TD in pregnancy in Nepal Medical College Teaching Hospital (NMCTH), Antithyroid Peroxidase Antibody (TPO-Ab) positive cases with hypothyroidism and to evaluate maternal fetal outcome in hypothyroid pregnancies. This was a prospective hospital based observational study. The study was done in Department of Obstetrics and Gynecology, NMCTH from August 2018 to July 2019. Among 420 pregnant ladies 71.0% were euthyroid, 25.7% were hypothyroid (25.2% of subclinical and 0.5% overt), 3.3% were hyperthyroid (0.7% of overt) and 6.4% were TPO-Ab positive with hypothyroidism. Inspite of treatment, Gestational hypertention, Pre-eclampsea and LSCS is significantly high in hypothyroid pregnancy than euthyroid pregnancy. High prevalence of hypothyroidism in this study necessitates universal screening of TD at first trimester of pregnancy. 1Department of Obstetrics and Gynaecology, 2Department of General Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal

5 citations


Journal ArticleDOI
TL;DR: Evaluated the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center in Nepal, finding prevalence of hypertension and diabetes was high, and high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy.
Abstract: The risk of cardiovascular disease is higher in chronic kidney disease patients compared to the general population and its impact is higher in developing countries compared to the developed countries. With this background in mind, we aimed to evaluate the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center. Chronic kidney disease patients aged 18 years and above who were under maintenance hemodialysis in the hemodialysis unit of Nepal Medical College were included in the study. Pre-dialysis venous blood samples from the participants were collected and analyzed for serum calcium, phosphorus, total protein, albumin and hemoglobin. Calcium phosphate product was calculated. Out of 100 study participants, 52% were male and 48% were female. Age-wise distribution showed 38% of the participants were below 40 years. The mean age of the participants was 45.86 ± 14.4 years. Ninety-three percent had hypertension and 29% had diabetes mellitus. Hypocalcemia was present in 80%, hyperphosphatemia was seen among 81% and high calcium phosphate product was present in 33% of the participants. Low hemoglobin (< 10gm/dL) was found in 86%. The cardiovascular risk trend in the Nepalese chronic kidney disease population is fairly different compared to the western population. Participants were younger. Prevalence of hypertension and diabetes was high. The high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy. Inadequately managed hyperphosphatemia despite the widespread use of phosphorus binders, is still a major clinical challenge in patients on hemodialysis.

5 citations


Journal ArticleDOI
TL;DR: It is necessary to consider ABS in prenatal screening with a high index of suspicion as early screening can allow a timely therapeutic strategy and reduce the severity of the associated defects.
Abstract: Amniotic band syndrome (ABS) is a rare, but serious congenital syndrome complex. It is associated with a wide range of fetal structural anomalies, notably craniofacial and limb anomalies. Early prenatal diagnosis is important to provide accurate information to the parents, predict the prognosis and in some cases perform in-utero lysis of the bands to restore the blood flow to the affected limb. A postnatal multidisciplinary approach involving vascular decompression, reconstructive surgery, prosthesis, and physiotherapy are some of the therapeutic options. It is necessary to consider ABS in prenatal screening with a high index of suspicion as early screening can allow a timely therapeutic strategy and reduce the severity of the associated defects.

4 citations


Journal ArticleDOI
TL;DR: To evaluate the biofilm forming abilities of the clinical isolates of Pseudomonas aeruginosa and to correlate biofilm formation with antibiotic resistance, 90 consecutive isolates obtained from patients visiting the Manipal Teaching Hospital, Pokhara, Nepal between January 2018 October 2018 were studied.
Abstract: Background: Clinical isolates of Pseudomonas aeruginosa often exhibit multidrug resistance due to their inherent ability to form biofilms. Drug resistance in Pseudomonas aeruginosa is a major clinical problem, especially in the management of patients with nosocomial infections and those admitted to ICUs with indwelling medical devices. To evaluate the biofilm forming abilities of the clinical isolates of Pseudomonas aeruginosa and to correlate biofilm formation with antibiotic resistance.

4 citations


Journal ArticleDOI
S Pudasaini1, PP Pant1, N Kafle1, S Maharjan1, A. Kc1, S Shrestha1 
TL;DR: This study revealed that the prevalence of anemia increases with age and was more common in females, and baseline study of red blood cell indices and reticulocyte count will help in indiagnosing the type ofAnemia and in further management.
Abstract: Anemia is not a disease but a clinical feature of some other underlying problems. It is one of the mostcommon public health problems in developing countries. The prevalence of anemia differs according tothe age group. A cross sectional observational study was conducted in a tertiary hospital, over a period ofsix months (January 2018 to June 2018). All the cases of anemia in different age group with hematologicalinvestigations (hemoglobin and red blood cell indices) including reticulocyte count during the studyperiod were included. A total of 274 blood samples of persons with anemia were evaluated. The mean ageof the patients was 41.4 ± 25.37 years. Anemia was more commonly seen in females (68.2%) than males(31.8%) in our study. The most affected age group for anemia was person ≥ 15 years followed by children< 5 years. The least affected group was children of 12- 14 years. Microcytic anemia (decreased MCV anddecreased MCHC) was observed in children of 12- 14 years and macrocytic anemia (increased MCV) wasseen in group ≥ 15 years. Red cell distribution width (RDW) was more elevated in children of 12 -14 yearsand showed that there was significant variation of size of RBC in this group. Reticulocyte count was higherin children < 5 years and lower in children of 12- 14 years. Significant correlation was noted for hematocritand reticulocyte count. This study revealed that the prevalence of anemia increases with age and wasmore common in females. Baseline study of red blood cell indices and reticulocyte count will help us indiagnosing the type of anemia and in further management. Keywords : Anemia, hemoglobin, hematocrit,red cell indices, reticulocyte

4 citations


Journal ArticleDOI
TL;DR: Community based, cross-sectional, analytical study in Kathmandu, Nepal found that the Indian Diabetes Risk Score (IDRS) may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population.
Abstract: Diabetes has been recognized as a “global health emergency” with an estimated 9% of adults being affected. However, about half of these adults remain undiagnosed. Conventional screening tools like fasting plasma glucose (FPG), oral glucose tolerance testing (OGTT) and glycosylated haemoglobin (HbA1c) can be inconvenient and expensive in a community-based setting. The Indian Diabetes Risk Score (IDRS) is a simple, non-invasive tool which has been validated for use in the Indian population. Age, abdominal obesity, family history of diabetes and physical activity levels have been weighted for a maximum score of 100. Persons with IDRS of 60 as high risk for diabetes. A community based, cross-sectional, analytical study was planned to assess the performance of IDRS among adults in a semi-urban area in Kathmandu, Nepal. A total of 256 (170 female, 86 male) persons without diabetes from 260 households were screened during the study period. A majority (46.09%) were classified as high risk, 44.53% as moderate risk and 9.38% as low risk for developing diabetes. Among them, 162 (63.28%) volunteered for definitive testing. The prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI: 1.75% to 8.70%) and 7.14% (95% CI: 3.89% to 12.58%) respectively. IDRS predicted the combined risk of diabetes and prediabetes with sensitivity of 84.21% and specificity of 55.24% in adults with score of 60 and above. The area under the ROC curve (AUC) of IDRS for identifying diabetes and prediabetes was 0.69 as compared to the gold standard (2hour Plasma Glucose) AUC of 0.98. IDRS may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population. Keywords : Diabetes, IDRS, prediabetes,screening, sensitivity, specificity

Journal ArticleDOI
TL;DR: NOSE scale is a valid, reliable and responsive instrument that is brief and easy to complete and has potential use for outcome studies in adults with nasal obstruction, showed that septoplasty, if done in properly selected patients, results in significant improvement in nasal obstruction and disease specific quality of life with high patient satisfaction.
Abstract: Nasal obstruction, the most common presenting symptom in nasal and sinus disease, is defined as patient discomfort manifested as a sensation of insufficient airflow through the nose. Nasal septal deviation is the most common anatomical cause of nasal obstruction. Surgical correction of a deviated septum, nasal septoplasty, is the definitive treatment for septal deviation. Many studies have discussed about outcomes of septoplasty. However, there is limited published literature on nasal septoplasty and its outcome in Nepal. The aim of this study is to evaluate the outcome of septoplasty using Nasal Obstruction Symptom Evaluation (NOSE) scale, a validated outcome instrument assessing quality of life (QoL) related to nasal obstruction. A total of 52 patients aged 18 years and above, with nasal obstruction at least for 3 months, undergoing septoplasty alone were included in the study. Baseline NOSE score was calculated a week before surgery. The patients were followed up after 3 months to record postoperative NOSE score. On statistical analysis, the mean NOSE scores before and 3 months after septoplasty were 45.58±21.38 and 8.46±8.37 respectively. The mean difference was 37.11± 21.22 and p value on paired t test was less than 0.001(highly significant). The mean differences of each component of the NOSE scale questionnaire were also found to be highly significant statistically with p values less than 0.001. Gender and age did not seem to affect the outcomes. In conclusion, NOSE scale is a valid, reliable and responsive instrument that is brief and easy to complete and has potential use for outcome studies in adults with nasal obstruction. This instrument showed that septoplasty, if done in properly selected patients, results in significant improvement in nasal obstruction and disease specific quality of life with high patient satisfaction.

Journal ArticleDOI
TL;DR: Care givers experience stigma such as concealment, negative experience, emotional stigma as well as work related stigma which affects the health and recovery of mentally ill persons.
Abstract: The lives of people with mental illness are altered by the symptoms of the illness, attitudes of people that view symptoms as threatening and uncomfortable, which foster stigma and discrimination within social circles. The catch of the study was to assess the stigmatizing beliefs among Caregivers of persons with mental illness. A descriptive and exploratory study was conducted with purposive sampling technique among 50 caregivers with interview method of mental illness patient with purposive sampling technique at Nepal Medical College teaching Hospital, Jorpati, Kathmandu, Nepal in Oct 2017Nov 2017. The study revealed that the most of caregivers (62%) feel burdened financially, and about 64% think that people with mental illness are dangerous. Most of the care givers(70%) think that the mentally ill people are violent. More than half (54%) of the caregivers think voluntary organizations are not doing adequate work in the field of mental health and 72% feel health organizations are giving less priority to mental illness as compared to other disorder. Most of the caregivers (66%) think that their occupational life has been interfered by the family member’s illness, and 56% don’t think that there are adequate law or rules regarding mental illness. In conclusion, care givers experience stigma such as concealment, negative experience, emotional stigma as well as work related stigma which affects the health and recovery of mentally ill persons. Compliance to medicine was poor and relapse rate was high which also have impact on the life of caregiver. Department of Nursing, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Ms. Srijana Pandey Department of Nursing, Nepal Medical College Teaching Hospital Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: srijanapandey2036@gmail.com ORCID ID: 0000-0002-9044-5104

Journal ArticleDOI
TL;DR: Late adolescence was significantly associated with depression and thoughts related to self harm were also six times more in late adolescent age group thanthe early adolescents age group.
Abstract: Depression which is characterized by hopelessness and loss of interest in social activities is commonduring adolescence However it is often unrecognized and the burden is even more in low incomecountries It also increases the risk of suicide in future Hence in a developing country like Nepalit is important that such cases are detected at the early stage preventing further worsening of thecondition A simple set of questionnaires like Patient Health Questionnaire (PHQ) 9 can be used toscreen for depression Using this questionnaire screening for depression was carried out in adolescentsof Gokarneshwor municipality, ward 4 Four hundred and twenty participants were selected by theprocess of systematic random sampling Based on answers to nine questions score was given andadolescents categorized as having no, mild, moderate or severe depression The PHQ 9 score suggestedthat 131% were suffering from depression, out of which 236% from moderate to severe depressionwhich required psychiatric consultation Out of those shown to have some form of depression 400%said they had thought of self harm in last 2 weeks Late adolescence was significantly associated withdepression Thoughts related to self harm were also six times more in late adolescent age group thanthe early adolescent age group Keywords : Adolescence, Depression,Gokarneshwor-4

Journal ArticleDOI
TL;DR: Femoral bicondylar angles were generally greater amongst the females as compared to themales; greater in right femur than left femur in both sexes.
Abstract: Femoral bicondylar angle is the angle between an axis through the shaft of the femur and a lineperpendicular to the infracondylar plane. This study aims to assess femoral bicondylar angle measuredfrom radiograph of femur and knee joints obtained from teaching hospitals in Kathmandu Nepal. Totalof two hundred AP view radiograph of knee joint were collected, out of which, 50 each were of male rightand left knee joint and 50 each were of female right and left knee joint. The mean angle for the right malefemur was 7.86° with the range of 5°-10° and mean angle for the right female femur was 8.82° with therange of 6°-11°. On the left side, bicondylar angle ranged in male from 6° -10° with the average of 7.46°andin female range was 6°-11° and average was 8.66°. The bicondylar angle was higher in female on both theside, the difference was statistically significant on the left side (P=0.004) and significant on the right side(P=0.001). The finding of the study showed the femoral bicondylar angles were greater in right femurthan left femur in both sexes. The difference in the bicondylar angle between the right and left femurwas statistically insignificant in both sexes. (male p=0.144, female p=0.541). The result from this study hasshown that femoral bicondylar angles were generally greater amongst the females as compared to themales; greater in right femur than left femur in both sexes. Keywords : Femoral bicondylar angle, femoraldiaphysis, infracondylar plane andmeasurement of radiograph

Journal ArticleDOI
TL;DR: Informing students about the “must know” and “good to know’ areas of the topics of every subject may be helpful to decrease the academic related stress.
Abstract: Educational environment in medical schools is highly demanding and stressful due to various factors. Thestudy was aimed to explore level of stress, stressors and the coping strategies among the undergraduatemedical, dental and nursing students of a medical college in Kathmandu. A cross- sectional observationalstudy was conducted among 174 consenting (95 medical, 51 dental and 28 nursing) first year undergraduatestudents with predesigned, pretested, semi-structured questionnaire which included socio-demographicdetails, Kessler psychological distress scale and Medical student stress questionnaire. Average age ofstudents was 19.54±1.28 years. Results revealed that 66.66% of students were under stress with 25.86%having mild, 18.96% having moderate and 21.83% having severe levels of stress. Highest prevalence ofstress was noted among nursing students (75.00%) with 32.14% under severe stress. Among 116 malesand 58 females, males were more stressed (75.00%) than females (50.00%). Most of the students enjoyedmusic and chatted with their close ones to cope with stress. Academic related stressor was found to be themajor stressor (2.65±0.69) with statistically significant association (p< 0.01) with the stress levels amongthe students. Informing students about the “must know” and “good to know” areas of the topics of everysubject may be helpful to decrease the academic related stress. Regular practice of meditation, sports andcultural activities may help to reduce stress. Keywords : Kessler psychological distress scale,medical student stress questionnaire,stress, stressors

Journal ArticleDOI
P Rijal1, L Lama1, S Shrestha1, P Kakshapati1, R Nayak1 
TL;DR: The aim of this study was to find out the prevalence and risk factors associated with recurrent pneumonia in children and to determine possible strategic plan needed for better clinical outcome.
Abstract: Recurrent pneumonia usually occurs due to an underlying disorder that negatively affects local orsystemic defence mechanisms The aim of this study was to find out the prevalence and risk factorsassociated with recurrent pneumonia in children and to determine possible strategic plan needed forbetter clinical outcome Children between 2 months to 15 years old who had a history of 2 or moreepisodes of pneumonia per year, or 3 or more episodes in a life time were investigated prospectively atNepal Medical College Teaching Hospital Out of 653 children admitted for pneumonia, 74 (113 %%) metthe criteria for recurrent pneumonia Among 74 children with recurrent pneumonia, underlying riskfactors was demonstrated in 65 patients (878%) Most common underlying diseases were aspirationsyndrome in 216% patients, congenital heart disease in 135% patients and bronchial asthma in121% children No predisposing illness could be demonstrated in 121% patients Approximately 1 in9 children with pneumonia in our hospital had recurrent pneumonia Aspiration syndrome was themost common underlying illnesses for undiagnosed recurrent pneumonia in children Keywords : Aspiration syndrome,bronchiectasis, immunedeficiency disorders, recurrentpneumonia

Journal ArticleDOI
TL;DR: Complete Blood Count parameters like Total leukocyte count (TLC), hemoglobin (Hb), platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) are found to be related with COPD and its acute exacerbation and can be used as an easily measurable AECOPD biomarker.
Abstract: Chronic obstructive pulmonary disease (COPD) is a major global health problem. It is a complex disease characterised by chronic inflammation in the airways by noxious particles. Episodes of increased symptoms called as acute exacerbations are associated with accelerated decline in the lung function. Blood cultures to find out the causative organism in these cases are time consuming. Complete Blood Count (CBC) parameters like Total leukocyte count (TLC), hemoglobin (Hb), platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) are found to be related with COPD and its acute exacerbation. An observational hospital based descriptive study was conducted for a period of six months in the Department of Pathology and Medicine of a tertiary care centre. A total of 144 patients of COPD with acute exacerbation (AECOPD) were included in the study. The mean age of the patients was 70.47 ± 9.49 years with female preponderance (61.1%). Though mean hemoglobin level (13.25 ± 2.70 gm %), (95% CI 12.80-13.69) showed statistical significance, other CBC parameters had no obvious difference among the different groups of AECOPD patients. But we cannot deny on the clinical significance of these parameters. The TLC and platelet count were slightly lower in the AECOPD patients with cor pulmonale when compared with AECOPD patients without cor pulmonale. Similarly, platelet parameters like MPV and PDW were slightly higher in the AECOPD patients who are smokers. Though these parameters were not statistically significant, they are found to be cost effective, time saving and clinically significant which would definitely help in the management of AECOPD patients. Hence, these parameters can be used as an easily measurable AECOPD biomarker.

Journal ArticleDOI
TL;DR: FCG may be a suitable, sensitive, and convenient screening tool for diabetes and prediabetes in community-based settings and larger prospective studies may validate the cost-effectiveness and efficiency of similar screening strategies in the Nepalese community.
Abstract: The natural history of type 2 diabetes includes a preceding period of impaired fasting glucose or impaired glucose tolerance which is referred to as prediabetes. During the asymptomatic phase of prediabetes, an estimated 20-30% of persons may develop complications like retinopathy, cardiovascular disease, neuropathy and nephropathy. Screening and lifestyle management may help to delay or arrest progression to diabetes. In primary care settings, point of care devices that measure glucose in capillary blood can be used for diagnosis of diabetes. This study was carried out to evaluate the performance of fasting capillary glucose (FCG) and fasting plasma glucose (FPG) measurement in screening for diabetes and prediabetes among adults in a semi-urban community in the Kathmandu district of Nepal. An observational, cross-sectional study design was used and FCG, FPG performance was evaluated by the 2-hour plasma glucose levels (2-hr PG) following Oral glucose tolerance test (75g glucose) using WHO 1998 criteria. Linear regression was performed to assess correlation co-efficient (r) between FPG, FCG and 2 hr PG. Bland Altman plot and Receiver operator characteristic (ROC) curves were constructed to assess concordance, measure ROC AUC and determine sensitivity and specificity of the measurements at recommended cut-off values for identifying diabetes and prediabetes. Among the study participants (n=162), 104 were female and 58 were male. Prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI 1.75% to 8.70%) and 7.14% (95% CI 3.89% to 12.58%). Strong positive correlation was seen between FPG and FCG (Spearman’s r 0.67). FPG & FCG had a moderate positive correlation (r = 0.49 & 0.45) with 2 hr PG levels (p<0.0001). FCG and FPG ROC AUC was 0.91 (95% CI 0.85 to 0.97) and 0.87 (95% CI 0.78 to 0.97) in comparison to 0.98 (95% CI 0.97 to 1.0) for the gold standard 2 hr PG. At 110 mg/dl and above, FCG had an optimal sensitivity and specificity of 84.21% and 81.12% in comparison to 47.37% and 100% for FPG. At 100 mg/dl, the sensitivity and specificity of FCG was 100% and 51.75% in comparison to 57.89% and 97.20% for FPG. In conclusion, at each recommended cut-off value, FCG was more sensitive than FPG with no significant difference between ROC AUCs of the two tests. Hence, FCG may be a suitable, sensitive, and convenient screening tool for diabetes and prediabetes in community-based settings. Larger prospective studies may validate the cost-effectiveness and efficiency of similar screening strategies in the Nepalese community.

Journal ArticleDOI
TL;DR: Parental history of refractive error was observed to be significantly associated with that of the medical students, and asignificant association betweenRefractive error and the daily use of mobile phones and laptops was observed.
Abstract: Refractive error is a defect in the optical system of the eye which prevents light from being brought toa single point focus on the retina, thus reducing normal vision. This optical defect is the second mostcommon cause of visual impairment globally as well in Nepal. At present, there are 285 million visuallyimpaired people in the world. An estimated 4 out of 5 visual impairment (80%) can be prevented or cured,uncorrected refractive errors are the leading cause (42%) followed by cataract (33%). A descriptive crosssectional study was conducted to determine the proportion of undergraduate medical students withrefractive errors in Nepal Medical College, and to identify factors associated with it. A total of 210 medicalstudents volunteered for this study, with 100 males (47.6%) and 110 females (52.4%). The age of thesestudents were between 18 to 26 years, with an average of 20.5 years. The proportion of medical studentswith refractive error was slightly more than half (51.4%), with simple myopia being the leading type(42.9%), followed by astigmatism (7.1%) and simple hypermetropia (1.4%). Parental history of refractiveerror was observed to be significantly associated with that of the medical students. There was also asignificant association between refractive error and the daily use of mobile phones and laptops. However,years spent in medical education were not observed to be significant. Keywords : Associated factors, astigmatism,medical students, myopia,refractive error

Journal ArticleDOI
TL;DR: Pediatric Index of Mortality-2 (PIM 2) as a predictive scoring system in Pediatric critical care unit of Nepal Medical College Teaching Hospital (NMCTH) performed well and good calibration was observed across deciles of risk as measured by Hosmer-Lemeshow goodness of fit test.
Abstract: Various scoring system have been developed and are becoming essential part of Pediatric and other critical care units. The Pediatric department wants to introduce Pediatric Index of Mortality-2 (PIM 2) as a predictive scoring system in Pediatric critical care unit of Nepal Medical College Teaching Hospital (NMCTH). This was a prospective cohort study done in Pediatric Intensive Care Unit (PICU) of NMCTH. Study was done from August 2017 to December 2018. All cases admitted in ICU were taken consecutively from term newborn to 14 yrs of age. PIM 2 scoring system was done in all patients. PIM 2 performed well in terms of discrimination with area under curve for PIM 2 scor e was 0.809 with 95% Confidence Interval of 0.0709 to 0.910 and Standard Error of 0.051. Good calibration was observed across deciles of risk as measured by Hosmer-Lemeshow goodness of fit test with P value of 0.163, chi-square value of 11.752 (8). Mortality observed in our PICU was 28.4% with standardized mortality ratio of 1. PIM 2 scoring system performed well in our PICU.

Journal ArticleDOI
TL;DR: Clinical profile and outcome of patients who received renal replacement therapy in intensive care unit and sustained low efficiency dialysis as the modality of renal replacement Therapy are looked into.
Abstract: Acute kidney injury is a major complication in intensive care unit patients. It is associated withincreased in-hospital mortality and length of stay. The provision of renal replacement therapy inintensive care is not widely available in resource poor countries like Nepal. The study aims to lookinto clinical profile and outcome of patients who received renal replacement therapy in intensivecare unit. It was an observational study done from 1st October 2016 till 30th September 2017.Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacementtherapy were recorded. Statistical package for the social sciences version 17 was used for statisticalanalysis. There were total of 649 admissions in intensive care, among which 148 had kidney relatedcomplications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, ureand creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacementtherapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysisas the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septicshock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significantfor in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation whichwas statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis canbe done in patients on ionotropes and patients can be switched over to intermittent hemodialysis. Keywords : Intensive care unit, Nepal, renalreplacement therapy; sustainedlow efficiency dialysis

Journal ArticleDOI
A Dhungana1, RR Joshi1, AS Rijal1, KK Shrestha1, S Maharjan1 
TL;DR: The cartilage perichondrial composite graft is more rigid and thick so it is more resistant than fascia to anatomic deformation and necrosis and should be used for tympanic membrane reconstruction in high riskperforation without concern about affecting audiometric results.
Abstract: The objective of this study was to compare the graft uptake results and postoperative hearing ofmyringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high riskperforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal typewith high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement caseswere included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80cases were included for myringoplasty which were randomly allocated by lottery method with 40cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptakeresults were assessed after 6 weeks and postoperative hearing was evaluated and compared withinand between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrialcomposite graft group was 90% and 92.5%, respectively with no significance difference in the graftuptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalisfascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001)showing improvement in the hearing after surgery in both groups. The mean air bone gain were14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectivelywith no significant difference between the groups (p=0.469). The graft uptake rate and hearingresults after cartilage perichondrial composite graft are comparable to those of temporalis fasciagraft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it ismore resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend theuse of cartilage perichondrial composite graft for tympanic membrane reconstruction in high riskperforation without concern about affecting audiometric results. Keywords : Cartilage-perichondrium,chronic otitis media, high riskperforation, myringoplasty, puretone audiometry, temporalisfascia

Journal ArticleDOI
TL;DR: Findings suggested desirable occlusal characteristics and spacing in primary dentition, however, future longitudinal studies are required to examine whether the transition of these occlusion characteristics will lead to favorable outcome in permanent dentition.
Abstract: Occlusion in deciduous dentition varies among children of different populations and races. Paucity of information in Nepalese literature provided the motive for this study. The objective of this study was to examine the occlusal traits of Primary Dentition among children aged 2-6 year old. A cross-sectional study comprising total of 307 children all having deciduous teeth were included in the study. The dentition was examined using a mouth mirror and explorer under illuminated light in Department of Pedodontics and the data was recorded. All the children were screened for molar and canine relationship, overjet, overbite, spaced and non-spaced dentition. Out of the total, Mesial step terminal plane (62%-left; 58%-right), Flush terminal (33%-left; 36% -right) and Distal step (5%-left; 6%-right) were seen. Most of the children had class I canine relation (83%-left; 84%-right), ideal overjet (68.4%), overbite (63.1%) and spaced dentition. Statistical significant difference was found among the gender with respect to overjet. Presence of spacing was more in maxilla than in mandible which was statistically significant. These findings suggested desirable occlusal characteristics and spacing in primary dentition. However, future longitudinal studies are required to examine whether the transition of these occlusal characteristics will lead to favorable outcome in permanent dentition.

Journal ArticleDOI
TL;DR: Dyslipidemia is a metabolic abnormality leading to a persistent increase in the plasma concentration of cholesterol and triglycerides and Garlic, when given as supplement decreases Total Serum Cholesterol, Serum Triglycerides,Serum LDL Cholesterol and Serum VLDL Ch cholesterol and on the other hand it increases Serum HDL Cholesterol.
Abstract: Dyslipidemia is a metabolic abnormality leading to a persistent increase in the plasma concentration of cholesterol and triglycerides. Dyslipidemia is known to promote atherosclerosis. It is a complex disease and is a major risk factor for adverse cardiovascular events. Allium sativum commonly known as garlic has been found to have several medicinal value including, lipid-lowering property, blood pressure decreasing, anti-diabetic, anti-cancer and anti-oxidant activity. It was a double-blind, two-parallel-group, prospective interventional clinical trial. Total no of 112 patients were enrolled in the study and divided into two equal groups (56 in each group) viz; Group 1 (Lasuna TM) and Group 2 (placebo). Lipid profile was measured at day 0 and 90. Independent–sample‘t’ test was applied to find out the significant difference between the two groups, P-value being 0.05. The mean difference Total Serum Cholesterol, Serum Triglyceride, Serum LDL Cholesterol and Serum VLDL cholesterol on day 0 was nonsignificant with p being 0.539, 0.811, 0.230, 0.770 and 0.811 and on 90th day was significantly lower in group taking garlic with p being 0.001, 0.014, 0.003 and 0.008 respectively whereas Serum HDL cholesterol on 90th day was significantly higher in group taking garlic with p being 0.001. Garlic, when given as supplement decreases Total Serum Cholesterol, Serum Triglycerides, Serum LDL Cholesterol and Serum VLDL Cholesterol and on the other hand it increases Serum HDL Cholesterol. 1Department of Clinical Pharmacology and Therapeutics, 2Department of Internal Medicine, BPKIHS, Dharan, Nepal

Journal ArticleDOI
TL;DR: The normal morphology of liver was in 54.28% and anomalies in 45.71% of liver, and the most common anomalies were accessory fissures and lobes which were found in 32.86% of livers.
Abstract: The variations of liver like the accessory fissures and lobes are a potential source of diagnostic errors. The knowledge in the variations may help in diagnosis, treatment planning and minimize the risk of post operative complications. The present study was aimed to observe the morphological variations of livers. The study was done in 70 formalin fixed human livers and was observed for morphological variations. The present study concluded the normal morphology of liver was in 54.28% and anomalies in 45.71% of liver. The most common anomalies were accessory fissures which were found in 32.86% of livers. The second common anomalies were absence or incomplete fissure for ligamentum teres in 15.71% of livers. Then the enlarged papillary process was found in 11.43%, short gall bladder was in 10% and elongated left lobe was in 7.14%. The knowledge of normal and variant liver may contribute to the understanding of the liver disease and to achieve correct preoperative diagnosis; and to avoid intra-operative complications. Department of Anatomy, Kathmandu University School of Medical Sciences Dhulikhel, Nepal

Journal ArticleDOI
TL;DR: Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5 μg/kg and 1 μg/ kg, and both the doses were devoid of any significant adverse effects.
Abstract: Laryngoscopy and endotracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. This study was conducted with the objective of arriving at an optimal dose of dexmedetomidine that can attenuate the hemodynamic response to laryngoscopy and intubation with minimal side effects. The current study was conducted in 60 patients, posted for elective surgery under general anesthesia with endotracheal intubation. The patients were divided into two groups: Group A and Group B. Group A received dexmedetomidine 0.5 μg/kg and group B received dexmedetomidine 1 μg/kg intravenously over 10 min prior to induction of anesthesia. The anesthesia technique was standardized in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were monitored and recorded at 5 min and 10 min of completion of infusion of study drug, after induction, and at 1 min, 2 min, 5 min after intubation. The baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were statistically similar in both the groups. After the infusion of the study drug the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure at all times were comparable in both the groups. Episodes of hypotension and bradycardia were also statistically similar in both the groups. Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5 μg/kg and 1 μg/kg. Both the doses of dexmedetomidine were devoid of any significant adverse effects. Department of Anesthesiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal Corresponding author Dr. Chitra Thapa, Lecturer, Department of Anesthesiology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: tchitra50@yahoomail.com ORCID ID: 0000-0002-0778-8596

Journal ArticleDOI
TL;DR: The histopathological findings of cervical biopsy includingcervical polypectomy and hysterectomy specimens at Dhulikhel Hospital from January 2008 to December 2018 are useful in updating thehistopathological pattern of cervicalBiopsy.
Abstract: Cervical carcinoma is the most common gynecological malignancy and almost curable cancer, if identifiedat an early stage. Cervical biopsy remains the ‘gold standard’ for the diagnosis of precancerous cervicallesion. The objective of this study was to review the histopathological findings of cervical biopsy includingcervical polypectomy and hysterectomy specimens at Dhulikhel Hospital from January 2008 to December2018. Out of 2098 cases, almost half of the cases (49.3%) were of Brahmin/Chhetri castes. There weresignificant differences in mean ages among hysterectomy cases (47.55±9.26), cervical biopsy cases(43.08±11.50) and polypectomy cases (33.59±12.47) (p value < 0.005). Out of 925 cervical specimens (cervicalbiopsy and polypectomy), colposcopy and hysteroscopy were performed in 18.2% and 12.7%, respectively.Out of 1173 hysterectomies, there were 110 cases (9.4%) of malignancies and cervical cancer was the mostcommon (67, 60.9%). The mean age of cervical cancer patients was 52.87±11.94 years. Cervical cancerdetected in age group of 40 – 59 years was significantly high (p value < 0.005). Incidence of cervical cancerwas lowest in Brahmin/Chhetris (2.4%) compared to Newars (3.4%) and other Janajatis (12.8%) and thedifference was statistically significant (p value < 0.005). The findings of thisstudy is useful in updating thehistopathological pattern of cervical biopsies. Keywords : Biopsy, cervical cancer,colposcopy, hysterectomy,polypectomy

Journal ArticleDOI
TL;DR: Study showed significant changes in weight and volume of kidneys in gross morphology of albino mice after neonatal exposure with MSG, and increased urinary space and dilatation of proximal convoluted tubule and distal convoluted tubules were constant finding in experimental animals.
Abstract: Monosodium Glutamate (MSG) is a commonly used food additive. Scientists have found that MSG has toxic effects in several tissues and organs like neurons, liver, testes, ovary, kidneys etc due to oxidative stress both after exposure in neonatal period as well as in adult animal models. Although various reports have suggested that MSG has damaging effect in kidneys only few histological studies are available. This study was done to observe any histological changes in kidneys of albino mice after neonatal exposure with MSG. Study showed significant changes in weight and volume of kidneys in gross morphology. Increased urinary space and dilatation of proximal convoluted tubules (PCT) and distal convoluted tubules (DCT) were constant finding in experimental animals. There were loss of luminal microvilli and reduced height of lining cells of both PCT and DCT.

Journal ArticleDOI
TL;DR: Prescription with FDC and intravenous were significantly high in Obstetrics and Gynecology, and antibiotic use were high in Otorhinolaryngology with statistical significance of difference between mean.
Abstract: The main objective of this study is to analyze the prescribing pattern of medicine in outpatient departments of tertiary care centre in Kathmandu using World Health Organization (WHO) drug use prescribing indicators. As per WHO consideration, 100 prescriptions were taken from each outpatient departments (OPD) of Nepal medical college including Orthopedics, Obstetrics and Gynecology, Surgery, Medicine, Ophthalmology, Otorhinolaryngology, Pediatrics, Dermatology and Psychiatry. Analysis of variance (ANOVA) was used to assess the statistical significance between means between all departments. Among a total of 900, 47.7% were male and 52.3% were female. Average medicine per prescription was 2.43±0.039. Number of Medicines by generic name 76 (3.4%), antibiotics 416 (19.0%), Injection 34 (1.5%), from Essential Medicine List (EML) 1,312 (60.1%), Fixed Dose Combination (FDC) 468 (21.4%) and the polypharmacy (≥4) was 129 (14.3%). The average cost was NPR 404.72±19.3 (3.69$; 1$=109.41NPR) and duration of treatment was 16.43±0.73 days. Patient’s age had positive correlation with number of medicines (p=0.002) and negative correlation with antibiotics (p=0.988). Cost of treatment had positive correlation with number of medicines (p=0.00), EML (p=0.00), duration of treatment (p=0.00) and antibiotics (p=0.33). Average medicines, from EML, and antibiotic use were high in Otorhinolaryngology with statistical significance of difference between mean. Prescription with FDC and intravenous were significantly high in Obstetrics and Gynecology. Cost and treatment duration were significantly high in Psychiatry. Tertiary healthcares need to develop and implement specific guidelines for prescriptions writing and also should develop a system to record them.