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Showing papers in "Nepal Medical College journal in 2020"


Journal ArticleDOI
TL;DR: This study proves that DIPSI criteria is comparable to WHO 2018 criteria and can be adopted in this institution for the diagnosis of GDM as it is more feasible, easy and less expensive.
Abstract: Gestational Diabetes Mellitus (GDM) is an important public health problem. Prevalence has shown an increasing trend and varies based on diagnostic criteria used and the ethnic group studied. It is more common in Asia. Presently, there is no international consensus on the screening and diagnostic criteria for GDM. The Diabetes in Pregnancy Study Group of India (DIPSI) guidelines recommend the non-fasting 75g oral glucose tolerance test (OGTT) as a single-step screening and diagnostic test for GDM, is simple, easy and more feasible. The objective of this study was to compare whether the DIPSI criteria is equally sensitive to WHO 2018 criteria. This was a hospital based cross-sectional study done at Nepal Medical College Teaching Hospital, Kathmandu. Among 425 cases, 25 (5.88%) were diagnosed GDM, 6 (1.41%) were diagnosed only by DIPSI, 5 (1.18) only by WHO 2018 and 14 (3.29%) by both methods. The study showed that the sensitivity of DIPSI was 73.68% and specificity was 98.52%. The agreement between the DIPSI and WHO 2018 criteria ranged from 60% to 80% (Kappa value = 0.68). This study proves that DIPSI criteria is comparable to WHO 2018 criteria and can be adopted in our institution for the diagnosis of GDM as it is more feasible, easy and less expensive. 1Department of Obstetrics and Gynegology, 2Department of Biochemistry, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal Corresponding author Dr. Biloni Shrestha (Vaidya) Assistant Professor, Department of Obstetrics and Gynecology, Nepal Medical Collage and Teaching hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: drbiloni@hotmail.com Orcid ID: 0000-0001-5747-3683 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30023

4 citations


Journal ArticleDOI
TL;DR: The results of this study show that tooth wear is a consequence of aging and there is an association between tooth wear and dentinal hypersensitivity.
Abstract: Tooth wear is a universal consequence of aging. It is an irreversible, multifactorial and destructive loss of dental hard tissues caused by either a mechanical or chemical process in the absence of caries or trauma. It can be a physiological and age dependent process. The risk factors that contribute to tooth wear are diet, bruxism, environment, occupation, oral health behaviour, acid regurgitation and use of tobacco. This study was done to find out if there is an association between tooth wear and its associated factors. So that we can educate the patients about the various factors causing tooth wear and minimise it. This cross sectional study was done amongst 339 patients. The clinical assessment of tooth wear was done using tooth wear index developed by Smith & Knight. A specifically designed questionnaire was used to seek information on risk factors of tooth wear. All patients were categorised into one of the following groups: Low Tooth Wear group, Moderate Tooth Wear group, Severe Tooth Wear group based on their individual tooth wear surface scores. Data were analyzed using Pearson’s chi-square test and descriptive statistics were calculated. We can see that the severity of tooth wear increases with age i.e, p≤0.05 which is statistically significant. Patients with self reported tooth sensitivity (60.5%) had a higher total tooth wear score than those who didn’t (39.5%) and the result was statistically significant. The results of our study show that tooth wear is a consequence of aging and there is an association between tooth wear and dentinal hypersensitivity.

4 citations


Journal ArticleDOI
TL;DR: The anatomical knowledge of the Brocq and Mouchet triangle regarding arterio-venous relationship will be required for angiographic procedures as it is a potential epicardial access route to mitral valve annulus thus detailed anatomical knowledge will help cardiologist to achieve successful cardiological procedures with minimal complications.
Abstract: Right and left coronary arteries maintain the nutritional supply of heart. The left coronary artery (LCA) bifurcates into Anterior Interventricular Artery (AIA) and Circumflex Artery (CA). Triangle of Brocq and Mouchet is an arterio-venous triangle formed by AIA and CA of left coronary artery and great cardiac vein (GCV) that lies between conus aretriosus and left auricle. This study aims to determine frequency of Brocq and Mouchet triangle and its anatomical details. This study was conducted in thirty formalin fixed cadaveric hearts collectively available in the Department of Anatomy, Nepal Medical College from November 2019 till April 2020. The incidence of heart showing the triangle was 93.3% with the most common type being closed which is followed by inferiorly opened, superiorly opened, and completely opened. Most frequent content of the triangle was median artery followed by diagonal branches of AIA and CA. the mean area of the triangle was 218.84mm2(527.97 mm2-57.26 mm2). The branches of LCA varied from bifurcation to pentafurcation. Relationship of GCV with AIA and CA was found to be either superficial or deep. The anatomical knowledge of the Brocq and Mouchet triangle regarding arterio-venous relationship will be required for angiographic procedures. Also, the triangle is a potential epicardial access route to mitral valve annulus thus detailed anatomical knowledge of the triangle will help cardiologist to achieve successful cardiological procedures with minimal complications. Department of Human Anatomy, Nepal Medical College, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Ms. Rabita Kharbuja, Lecturer Department of Human Anatomy, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: 1rabitakharbuja@gmail.com Orcid ID: https://orcid.org/0000-0001-8786-4829 DOI: https://doi.org/10.3126/nmcj.v22i3.32626

4 citations


Journal ArticleDOI
TL;DR: A prospective observational study among patients diagnosed with TB at DOTS center in BPKIHS from June 2017 to May 2018 and occurrence of any ADRs were detected during their monthly visit to identify the pattern of ADRs caused by ATD and the drug utilization pattern (DUP) in different types of tuberculosis.
Abstract: Most of anti-tubercular drugs (ATD) cause various adverse drug reactions (ADRs) leading to significant morbidity which may have negative consequences on drug adherence and treatment outcome. The objectives of the study were to know the clinical profile of patients receiving ATD, to identify the pattern of ADRs caused by ATD and to know the drug utilization pattern (DUP) in different types of tuberculosis (TB). A prospective observational study was conducted among patients diagnosed with TB at DOTS center in BPKIHS from June 2017 to May 2018 and occurrence of any ADRs were detected during their monthly visit. Descriptive statistics were used to analyze the data. A total of 126 tuberculosis patients were on ATD therapy during the study period. Seventy five patients (59.5%) were male. Most of the patients (44.4%) belonged to age group 21-40 year. Pulmonary TB (66.7%) was more common than extra-pulmonary TB. Multi-drug resistant TB was detected in 4 patients (3.2%). Seventy one patients (56.3%) were found to be smear positive for acid fast bacilli. First line ATD was given to 122 patients (96.8%). Out of 126 patients, 116 (92.1%) reported occurrence of at least one ADR. A higher number of ADRs were observed in male (68.3%). Change in urine color was the most common ADR (92.9%) followed by nausea and vomiting (39.7%). Further studies covering different regions of Nepal are needed to generalize the findings. 1Department of Drug Administration, Kathmandu, 2Department of Clinical Pharmacology and Therapeutics, 3Department of Microbiology, 4Department of Orthodontics, College of Dental Surgery, BPKIHS, Dharan, Nepal. Corresponding author Dr. Aswani Chaudhary, Clinical Pharmacologist, Department of Drug Administration, Kathmandu, Nepal. Email: chaudharyaswani@gmail.com Orcid ID: https://orcid.org/0000-0002-9484-5527 DOI: https://doi.org/10.3126/nmcj.v22i3.32650

3 citations


Journal ArticleDOI
TL;DR: Most of the people in productive age groups were preobese and were in prehypertensive stage which may increase the risk of acquiring diabetes mellitus in future.
Abstract: Diabetes mellitus is a chronic disease that through its complications can seriously impact the quality of life of an individual. The incidence of diabetes mellitus is starting to rise at a younger age. This study is carried out to determine the prevalence of diagnosed diabetes mellitus in productive aged persons and to study the association of socio-demographic characteristics, body mass index (BMI) and blood pressure among persons with and without diabetes mellitus. A community-based cross-sectional, observational study was conducted in Makalbari area. Systematic random sampling technique was used to select the households. The family members from those households who met the inclusion criteria were interviewed with self-constructed semi-structured questionnaire which included socio-demographic information of respondents. Height, weight and blood pressure were recorded. BMI was interpreted as per WHO guidelines and hypertension was defined as per Joint National Committee (JNC) VII guidelines. Among total 662 participants, 342 (51.7%) were female and 320 (48.3%) were male. About 196 (29.6%) of subjects were between 25 to 34 age group followed by 145(21.9%) of them in 35 to 44 age group. Prevalence of diagnosed diabetes mellitus in productive aged persons in urban area was 3.8%. The prevalence of BMI of ≥25 was 42.4%. Out of total subjects, maximum number of respondents were prehypertensive 406 (61.3%). Mean age of total participants was 37.9±13.59 and BMI was 24.15±3.89.The age of respondents was highly statistically significant among the persons with diabetes (p = 0.000). The number of diabetes mellitus increased with increase in age and BMI of the participants. Prevalence of diabetes mellitus was almost same in both male 13 (52.0%) and female 12 (48.0%). Diabetes mellitus was seen more in subjects who had completed secondary level education 11 (44.0%) and in homemakers and government job holders, 3 (33.3%) each. In conclusion, most of the people in productive age groups were preobese and were in prehypertensive stage which may increase the risk of acquiring diabetes mellitus in future. This necessitates the screening of more persons in productive age group for diabetes mellitus. Department of Community Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr Bharati Shakya, Lecturer Department of Community Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneswor-8, Kathmandu, Nepal, Email: shakyabharati@hotmail.com Orcid ID: http://orcid.org/0000-0001-7834-168X DOI: https://doi.org/10.3126/nmcj.v22i3.32653

3 citations


Journal ArticleDOI
TL;DR: Evaluated neutrophil count, Neutrophil/Lymphocyte ratio, MPV, and PDW correlated with other inflammatory biomarkers and can be used to assess the patient with arthritis.
Abstract: Osteoarthritis, rheumatoid arthritis, and gout are frequently encountered diseases in the orthopedic clinic. CRP is done to evaluate and monitor these disease processes. This study aimed to evaluate total leukocyte count with differential count, neutrophil/lymphocyte ratio, platelet, platelet/lymphocyte ratio, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit in patients with arthritis. This was a cross-sectional study conducted at KIST Medical College, Teaching Hospital from 15 Ashad 2075 to 14 Ashad 2076. The patient’s demographic data and laboratory findings: total leukocyte count, differential count, hemoglobin, platelet count, plateletcrit, mean platelet volume, platelet distribution width, and plateletcrit. CRP, ESR, RA factor/anti-CCP, and Uric acid tests were also performed. Among 67 patients, osteoarthritis was seen in 53 (79.1%), rheumatoid arthritis among 11(16.4%), and Gout among 3(4.5%). The ROC area under the curve was within acceptable limits for the neutrophil count, neutrophil/lymphocyte ratio, mean platelet volume, platelet distribution width. The sensitivity and specificity of the neutrophil count were 75% and 62% respectively (cut-off: 64.5%). Neutrophil/Lymphocyte ratio was increased and correlated with CRP (p-value: <0.001). PDW had a sensitivity of 90% and specificity of 83.0% (cut-off: 16.8 CV). For MPV, the sensitivity was 80% and specificity was 81% (cut-off: 9.1 fL). At 1.92 cut-off value, the sensitivity and specificity of neutrophil/lymphocyte ratio were 80.0% and 62.0% respectively. CBC parameters can provide an important clue to the treating physician, which helps to manage a patient with arthritis effectively. Neutrophil count, Neutrophil/Lymphocyte ratio, MPV, and PDW correlated with other inflammatory biomarkers and can be used to assess the patient with arthritis. 1Department of Pathology, 2Department of Orthopedics, 3Intern, KIST Medical College Teaching Hospital, 4Department of Pathology, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal. Corresponding author Dr. Shiva Raj KC, MD Associate Professor and Chair, Department of Pathology and Laboratory Medicine, Patan Hospital, Lalitpur, Nepal Email: shivarajkc074@gmail.com Orcid ID: https://orcid.org/0000-0002-2107-5322 DOI: https://doi.org/10.3126/nmcj.v22i3.32621

2 citations


Journal ArticleDOI
TL;DR: The results revealed that the fluoride content in drinking water of Kathmandu valley was below the permissible limit as per Nepal’s drinking water quality standards and World Health Organization (WHO) guidelines.
Abstract: Fluoride has a preventive effect on dental caries. However, excessive/insufficient ingestion of fluoride can lead to the development of dental fluorosis/increased risk for dental caries respectively. The objective of this study was to estimate fluoride concentration in drinking water of Kathmandu valley. It was a community based cross-sectional study in which drinking water samples were collected from municipal water supply and bottled water. Municipal water supply was collected according to eight water schemes in Kathmandu valley and as for bottled water, 35 samples were randomly collected according to different brand names available in the commercial market. The samples were analyzed for fluoride content by SPADNS colorimetric method as per standard procedure set by American Public Health Association (APHA 2012).The results revealed that the fluoride content in drinking water samples was below the permissible limit (<0.5 ppm) as per Nepal’s drinking water quality standards and WHO guidelines. Hence, implementation of water fluoridation program can be initiated for municipal water supply and bottled water for prevention of dental caries to optimize the oral health of people. Department of Pedodontics and Preventive Dentistry, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Priyanka Shah Lecturer, Department of Pedodontics and Preventive Dentistry, Nepal Medical College, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal. Email: picu.shah@gmail.com Orcid ID: 0000-0003-3167-0595 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30031

2 citations


Journal ArticleDOI
TL;DR: In this article, a longitudinal observational study using purposive sampling technique was conducted among 196 infants and the information regarding socioeconomic characteristics of mother, gender of the infant, place of delivery of child, birth order and reasons for dropout of pentavalent third dose were taken.
Abstract: Immunization is one of the most cost-effective public health measures as it has helped in huge reduction of disease, disability and death from different infectious diseases in children by protecting them from vaccine preventable diseases. The current study aimed to study factors associated with dropout for pentavalent vaccine in tertiary care hospital of Kathmandu. A longitudinal observational study using purposive sampling technique was conducted among 196 infants. The information was obtained using self-constructed structured questionnaire from parents visiting Community Medicine OPD of Nepal Medical College Teaching Hospital. The information regarding socioeconomic characteristics of mother, gender of the infant, place of delivery of child, birth order and reasons for dropout of pentavalent third dose were taken. The dropout of third dose pentavalent vaccine was mainly seen in infant of parents living in rented house and according to gender wise, dropout was high among male infants. The different reasons for dropout of vaccine were busy parents, forgotten date, visit to other immunization centres and sick infants. Among these, the main reason for dropout of vaccine was due to infants getting sick during the time of immunization. The dropout rates between first and third dose of pentavalent vaccine were 26.3% and 30.4% respectively for two consecutive months and the overall dropout rate was 28.35%. Also, literacy level of the mother was directly associated with the immunization visit of the infant as, maximum number of infants of illiterate mother were absent for third dose of pentavalent vaccine as opposed to no absentee among master degree holding mothers. Thus, the present study provides valuable information regarding the factors associated with dropout for pentavalent vaccine. 1Department of Community Medicine, 2Intern, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8,

2 citations


Journal ArticleDOI
TL;DR: Single setting ERCP+LC at the peripheral-level hospital is feasible in terms of cost, length of hospital stay, morbidity and stone clearance, and postERCP amylase value was found to be within the normal limit.
Abstract: The ideal management of cholecysto-choledocholithiasis is an open cholecystectomy (OC) with the common bile duct (CBD) exploration worldwide. The single setting 2-stage approachendoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST), and CBD clearance followed by laparoscopic cholecystectomy (LC) offers an advantage, mainly by reducing the hospital stay, the cost, and the morbidity. The Objective of the study is to compare the ERCP+LC single setting approach with an OC+CBD exploration for the treatment of cholecysto-choledocholithiasis. This is an interim analysis of 160 patients with 83 (51.9%) patients in ERCP+LC and 77 (48.1%) in an open procedure (OC+CBD exploration) group respectively. We did a prospective study in patients admitted for the management of the cholecysto-choledocholithiasis in the Department of Surgery at the Lumbini Medical College and Teaching Hospital from November 2012–October 2015. They underwent 2-stage ERCP+LC in a single setting and we compared them with 2-stage OC+CBD exploration in a single setting approach. The patients with the open procedure were our control group. All the included cases in the study were elective. The procedure was feasible in our hospital. Similarly, the hospital stay was significantly shorter in the ERCP+LC group; 3.92±0.719 days vs 10.30±1.557 days, p <0.05. There was a significant difference in the total morbidity of ERCP+LC group 7 (8.4%) vs 14 (18.2%), p <0.05. Here, wound infection in the ERCP+LC group was 2 (2.4%) vs 4 (5.2%) and there was one case of abdominal collection 1 (1.2%) which was managed symptomatically. The incidence of retained CBD stone in the ERCP+LC was 3 (1.2%) which was managed successfully with ERCP. In all the cases, postERCP amylase value was found to be within the normal limit. The result of our study suggests, single setting ERCP+LC at the peripheral-level hospital is feasible in terms of cost, length of hospital stay, morbidity and stone clearance. 1Department of Surgery, 1Lumbini Medical College and Teaching Hospital, Department of Surgery, Palpa 32500, Lumbini, 2Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal, Chitwan Medical College Teaching Hospital, 3Department of Surgery, Bharatpur, Chitwan 44200, Nepal Corresponding author Dr. Nabin Pokhrel Associate Professor, Department of Surgery, Nepal Medical College Teaching Hospital Gokarneshwor-8, Kathmandu, Nepal Email: nabin.pokharel@gmail.com Orcid ID: 0000-0002-8981-3336 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30038

2 citations


Journal ArticleDOI
TL;DR: A study to estimate the prevalence of dry eyes disease among pregnant women and to find its association with socio-demographic characteristics and their gestation period, at Nepal Medical College Teaching Hospital found the association between gestational age and dry eyes by Schirmer's test was statistically significant.
Abstract: Pregnancy is characterized by many significant changes in a woman’s body which helps develop the fetus optimally. During pregnancy, there is marked maternal endocrine upregulation, hormonal profile modifications and interactions leading to dry eyes. Pregnancy causes most parts of a woman’s body to change, and the eyes are no exception. Dry eye disease is a common pregnancy problem that usually begins towards the end of the first trimester. Since, there is a dearth of literature on dry eye disease during pregnancy in Nepal, a study was conducted to estimate the prevalence of dry eyes disease among pregnant women and to find its association with socio-demographic characteristics and their gestation period, at Nepal Medical College Teaching Hospital. A total of 84 pregnant women in different trimesters volunteered for this study. The upper and lower limits for estimated mean age were 26.67 years to 25.03 years at 95% confidence level. The prevalence of dry eyes was 89.3% by tear break up time test and 27.4% by Schirmer’s test respectively. The association between gestational age and dry eyes by Schirmer’s test was statistically significant. 1Department of Ophthalmology, 2Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneswar-8, Kathmandu, Nepal. Corresponding author

2 citations


Journal ArticleDOI
TL;DR: The effectiveness of prehydration with different fluids or applied muscle tension during blood donation in preventing or attenuating AE was assessed and role of the interventions in relation to AE could not be established.
Abstract: Adverse effects (AE) like vasovagal reactions (presyncope and syncope) have negative impact on old as well as new blood donors. Various methods have been suggested to prevent or attenuate AE in blood donors. This study assessed the effectiveness of prehydration with different fluids or applied muscle tension (AMT) during blood donation in preventing or attenuating AE. Consenting and eligible voluntary blood donors (n=448) were randomly allocated to Control (n=115), prehydration with 500 mL plain water (PW, n=97), prehydration with oral rehydration solution (ORS, n=71), prehydration with 400 mL fruit juice (FJ, n=74), or leg muscle tensing during blood removal (AMT, n=91) groups. Donors’ hemodynamic responses to blood donation were assessed by comparing blood pressures (systolic–SBP and diastolic–DBP) and heart rate (HR) recorded before blood removal to values midway during, and at 0 min, 5 min, 10 min and 15 min after blood removal. Presyncope and syncope were defined by BP and HR changes. Subjective AE were also recorded. Overall, 35 donors (7.8%) suffered AE with highest rates in PW (13.4%) and ORS (11.3%) groups and lowest in Control (3.5%) although group differences were not significant (p>0.05, Chi square). Blood removal was associated with significant falls in SBP and DBP (mean falls by 6.63 and 3.35 mmHg, respectively; p<0.001) but an insignificant rise in HR (mean increase by 0.67 bpm, p>0.05). Hemodynamic responses showed significant differences between groups (p<0.001, repeated measures ANOVA). Therefore, role of the interventions in relation to AE in blood donors could not be established. Department of Physiology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Mrigendra Amatya Associate Professor, Department of Physiology, Nepal Medical College, Gokarneswor-8, Kathmandu, Nepal Email: amatyam01@gmail.com Orcid ID: 0000-0002-0312-3220 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30034

Journal ArticleDOI
TL;DR: The synergistic and harmonic functions of retina, optic nerve, part of thalamus and visual cortex are essential for the perception of color: human color vision is trichromatic i.e. the mixture of red, green and blue lights.
Abstract: The synergistic and harmonic functions of retina, optic nerve, part of thalamus and visual cortex are essential for the perception of color: human color vision is trichromatic i.e. the mixture of red, green and blue lights. The present cross-sectional study was conducted in August to October 2018. The ethical approval was obtained from Institutional Review Committee (IRC) of Nepal Medical College. After obtaining consent from the participants, the study was carried out among health science students of age group 18-25 years at Jorpati, Kathmandu, Nepal. The number (n) of sample size was 300; (male, n=150, female, n=150). The assessment of color blindness was done with the help of Ishihara Chart (“Ishihara Type Tests for Color Blindness”-38 plates (2002) Eye CareLudhiana, India). Among the study group (male, n=150, female, n=150), the color deficiency were found in male participants only; n=7, which is 2.33% of total participants (n=300). None of the female participants were found to be color blind/weak. Among the color deficient (n=7), protanomaly detected in 1, deuteranomaly in 2 and deuteranopia in 4. Hence, the present students of health stream are future health workers, whose observation apt to clinical examination is instrumental to treat patients; therefore, they must be aware and circumspect of their color vision to discharge their duties to the patients in a better way. 1Department of Physiology, Nepal Medical College, Attarkhel, Gokarneshwor-8, 2Shankarapur Hospital, Jorpati, Gokarneshwor-6, Kathmandu, Nepal Corresponding author Mr. Rajan Pandit Assistant Professor, Department of Physiology, Nepal Medical College, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal. Email: pandit_rajan@yahoo.com Orcid ID: 0000-0001-9744-1248 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30033

Journal ArticleDOI
TL;DR: This study showed that the association between reduced sleep duration and abnormal BMI was significant even when confounding variables like tobacco or alcohol and poverty state were removed.
Abstract: Various studies have shown that abnormal body mass index (BMI) of an individual is linked to poor sleep. Abnormal BMI is a predisposing factor for many noncommunicable diseases like cardiovascular diseases and diabetes. However, if BMI is affected by sleep, detecting sleep abnormality followed by simple corrective measures may help in making BMI normal hence preventing the risk of many such diseases. Using Asian Classification for BMI and questions from Pittsburgh Sleep Quality Index (PQSI) a survey was carried out among persons aged 15 to 60 years in a ward of Gokarneshwor Municipality. In this study, out of a total of 563 persons 4.4% were underweight, 33.9% had normal BMI, 18.5% were overweight and 43.2% were obese. Around 22% reported a reduced duration of sleep but only around 5% of the persons felt that their quality of sleep was poor. This study showed that the association between reduced sleep duration and abnormal BMI was significant even when confounding variables like tobacco or alcohol and poverty state were removed. 1Department of Community Medicine, 2Intern, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr Niraj Shrestha Assistant Professor, Department of Community Medicine, Nepal Medical College Teaching Hospital Gokarneshwor-8, Kathmandu, Nepal Email: nishre15@gmail.com Orcid ID: 0000-0002-2974-9088 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30036

Journal ArticleDOI
TL;DR: Bacterial vaginosis was the most predominant type of cervicovaginal infection followed by TV infection and TV and BV co-infections and Trichomonas vaginalis may create an environment favoring the development of BV.
Abstract: Cervical-vaginal infections are common problems in women of reproductive age presented with clinical features like white vaginal discharge, foul smelling odor and pruritis. Trichomonas vaginalis, Candidia and Gardnerella vaginalis are responsible for infectious vaginitis in creating anaerobic environment favoring Bacterial vaginosis caused by organisms like Gardnerella vaginalis, Chlamydia Trachomatis. Papanicolaou (Pap) smear examination is the simple, quick, painless routine screening test used for identification and detection of precancerous changes of uterine cervix as well as the cervico-vaginal infections resulting from bacterial, fungal and candida infections. The prime objective of the study was to identify the age wise distribution of cervical-vaginal infections and determine the frequency of Trichomonas vaginalis (TV) and Bacterial vaginosis (BV). A descriptive cross-sectional study was carried out in the Department of Pathology, Nepal Medical College and Teaching Hospital, Kathmandu. A total of 163 cases of TV and BV diagnosed on Pap smear were taken for the study. However, 564 Pap smears were received in the Department of Pathology for cytological evaluation during the study period. Once the smears were stained, the presence of clue cells, cannon balls and Trichomonas were observed. Out of 564 Pap smears received during the study period, 163 cases were of BV, TV and combined BV and TV. These 163 cases were included in our study. The age ranged from 20 to 65 years with majority (19.1%) of the women belonging to 35-39 years and the mean age was 38.18 ± 10.18 years. There were 97 cases (17.2%) of BV, 50 cases (8.9%) of TV and 16 cases (2.8%) of TV and BV co-infection. Bacterial vaginosis was the most predominant type of cervicovaginal infection followed by TV infection and TV and BV co-infections. Trichomonas vaginalis may create an environment favoring the development of BV. Pap screening could be the beneficial tool in early disease diagnosis and helps in preventing further complications by starting appropriate treatment. 1Department of Pathology, 2Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshower-8, 3National Ayurveda Research and Training Center, Kirtipur, Kathmandu, Nepal Corresponding author Dr. Rakesh Pathak Assistant Professor, Department of Pathology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshower-8, Kathmandu, Nepal Email: dr_rakesh@hotmail.com Orcid ID: 0000-0003-0780-7416 DOI: https://doi.org/10.3126/nmcj.v22i1-2.29926

Journal ArticleDOI
TL;DR: The study aims to find out the diagnostic value of clinical examination, ultrasonography and Ca-125 and its correlation, using Risk of Malignancy Index with histopathological diagnosis in adnexal masses, using clinical records of women who had surgical management forAdnexal mass in the last 2 years duration.
Abstract: Adnexal mass is a common clinical finding in gynaecological practice. The study aims to find out the diagnostic value of clinical examination, ultrasonography and Ca-125 and its correlation, using Risk of Malignancy Index with histopathological diagnosis in adnexal masses. Clinical records were retrieved of women who had surgical management for adnexal mass in the last 2 years duration. Based on the data, Risk of Malignancy Index values were calculated. It was then compared with histopathological diagnosis. Out of 66 patients, 56 patients had benign tumor and 10 patients had malignancy. The Risk of Malignancy Index values of each patient was calculated which ranged from 8 to 2205 with mean value of 425.52 (SD±41.8). Risk of Malignancy Index sensitivity was 70%, specificity was 96.42%, positive predictive value was 77.78%, and negative predictive value was 95.83%. Risk of Malignancy Index is a reliable diagnostic tool in differentiating benign from malignant adnexal masses.

Journal ArticleDOI
TL;DR: The antibiotic resistance pattern of Gram-positive bacteria from patients with lower respiratory tract infection visiting Kathmandu University Hospital was determined and multidrug-resistant Gram positive bacteria were observed in respiratory samples.
Abstract: Respiratory tract infection due to Gram positive bacteria is a common cause of morbidity and mortality worldwide. This study of one year duration was carried out to determine the antibiotic resistance pattern of Gram-positive bacteria from patients with lower respiratory tract infection visiting Kathmandu University Hospital. A total of 1,556 respiratory samples including sputum and endotracheal aspirates were processed following standard guidelines. Antibiotic resistance pattern was determined following Clinical Laboratory Standard Institute guidelines. Gram positive bacteria from total sample were 6.6%. Out of them 86.4% were Streptococcus pneumoniae and 13.6% were Staphylococcus aureus. Majority of S. pneumoniae, 53.9% were resistant to azithromycin, followed by cotrimoxazole 40.4%, ciprofloxacin 13.5% and Ceftriaxone 1.1% but all isolates were sensitive to penicillin. A total of 92.9% S. aureus were methicillin and Ciprofloxacin resistant, 64.3% were resistant to cotrimoxazole and 28.6% resistant to amikacin but all strains were sensitive to linezolid. Majority of multidrug resistant Staphylococcus were detected among patients of age more than 60 years. A total of 77.8% patients had lower respiratory tract infection with acute exacerbation of chronic obstructive pulmonary disease. Majority of diabetic patients had multidrug resistant organism. 70.69% patients of age above 60 had multidrug resistant isolates. Multidrug-resistant Gram positive bacteria were observed in respiratory samples. For effective management of lower respiratory tract infections detailed microbiological diagnosis and susceptibility testing is required. 1Department of Microbiology, Kathmandu University School of Medical Sciences, 2Department of Internal Medicine, Dhulikhel Hospital, Dhulikhel, Nepal. Corresponding author Dr. Jatan Bahadur Sherchan, Associate Professor Department of Microbiology Kathmandu University School of Medical Sciences Dhulikhel, Nepal Email: jatansherchan@gmail.com Orcid ID: 0000-0001-8576-1631 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30028

Journal ArticleDOI
TL;DR: The tendency of patients to seek advice from pharmacy dispensers, use of topical steroid containing agents in chronic dermatophytosis and substantial financial burden borne by patients in the treatment of the condition were highlighted.
Abstract: Recent trend in onslaught of chronic and recurrent dermatophytosis not amenable to conventional dose and duration of antifungal agents has been observed in Nepal and India. The major factor implicated behind this surge is use of over-the-counter fixed drug combination containing topical steroids. This study aimed to examine the health seeking behavior, pattern of drug use and cost of care of chronic dermatophytosis in Nepalese population. Ninety-one patients with the diagnosis of chronic dermatophytosis of skin willing to participate in the study were recruited in a hospital-based, cross-sectional study. Information regarding demographic profile, health seeking behavior and cost incurred in the treatment of their dermatophytosis were recorded in a preset proforma. Mean age of study population was 30.49±13.50 years with M:F ratio of 2.25:1. Mean duration of illness was 20.68±6.44 months, with groin as the initial site of involvement in nearly half of cases. Commonest diagnoses were extensive dermatophytosis, followed by tinea cruris et corporis and tinea cruris. Nearly three-forth of patients reported seeking advice from local pharmacy and two-third reported using steroid containing topical agents for their skin problem. On an average, patients spent NPR 6,488.70 in a six months period and 3.03% of their income in the treatment of chronic dermatophytosis. This study highlighted the tendency of patients to seek advice from pharmacy dispensers, use of topical steroid containing agents in chronic dermatophytosis and substantial financial burden borne by patients in the treatment of the condition. 1Department of Dermatology and Venereology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, 2Department of Dermatology, Metro Hospital, Maharajgunj, 3Di Skin Health and Referral Center, Maharajgunj, Kathmandu, Nepal Corresponding author Dr. Smita Joshi, Lecturer Department of Dermatology and Venereology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: smitaz@gmail.com Orcid ID: http://orcid.org/0000-0002-1222-9916 DOI: https://doi.org/10.3126/nmcj.v22i3.32656

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TL;DR: It was concluded that Chronic cholecystitis was the most common histopathologcial findings and the common groups was 41-50 years and the average age was 40.54 years.
Abstract: Gall bladder is one of the important digestive organ which encountered with different histopathological changes. Different changes in dietary habit, obesity, oral contraceptives, alcohal have shows increased pattern of cholecystitis and cholelithiasis and other pathological findings. Detail examination of gall bladder in cholecystectomy specimen helps to evaluate different histopathological pattern of gall bladder lesion and also help to differentiate non-neoplastic from neoplastic lesion and also helps in further management. This was a cross sectional study done in the Department of Pathology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal, during the study of period of six months (Feburary 2020 to July 2020). A total of 127 patients between 16 years to 63 years with mean age of 40.54±10.88 years. There were 127 cholecystectomy specimens were received during study period and out of which 94 were female and 33 were male. On histopathologial evaluation, chronic cholecystitis was most common findings followed by chronic cholecystitis with cholesterolosis. Other findings were chronic cholecystitis with adenomyosis, chronic cholecystitis with pyloric metplasia, chronic cholecystitis with intestinal metpalsia, chronic cholecystitis with polyp, acute on chronic cholecystitis, Xanthogranulomatous cholecytsitis and adenocarcarcinoma . Median age was 40.54 years. It was concluded that Chronic cholecystitis was the most common histopathologcial findings and the common groups was 41-50 years. Routine examination of cholecystectomy specimens grossly and microscopically is important for patient management Though a very few cases of carcinoma of Gall bladder is seen, it is very important to make sure that all cholecystectomy specimens undergone histopathological examination, with this, we can achieve timely diagnosis and early managements.

Journal ArticleDOI
TL;DR: Most patients in MICU were at the risk of developing pDDIs and a substantial number of interactions had a major severity, suggesting a need for active surveillance for p DDIs to prevent patient harm during particular drug therapy.
Abstract: Drug interaction may cause an increase in the toxicity of a drug, increases the likelihood of adverse drug reactions, or cause a reduction in the efficacy of particular drug therapy, which may worsen the patient’s condition directly or indirectly. This study aims to assess the potential drug-drug interactions (pDDIs) and their associated factors in the Medical Intensive Care Unit (MICU). We carried out a descriptive retrospective study based on the hospital records of 100 MICU patients. Micromedex Interaction application, designed by Truven Health Analytics Inc., was used to screen prescribed medications. We found 219 drug interactions out of 856 drugs prescribed. The average number of drug interactions per patient was 2.19. The frequency of drugs prescribed, the number of days in MICU, and age had a positive correlation with the occurrence of pDDIs. There were 44.7% major pDDIs; pharmacodynamic being the commonest mechanism for it. Most patients in MICU were at the risk of developing pDDIs. A substantial number of interactions had a major severity. Therefore, there is a need for active surveillance for pDDIs to prevent patient harm during particular drug therapy.

Journal ArticleDOI
TL;DR: The prevalence of adenomyosis was 24% and was seen higher in the age group of 35-50 years and the most frequent co-pathology in these adenomeosis cases was leiomyoma, which is a common condition detected in 15-30% of hysterectomy specimens.
Abstract: Adenomyosis is a common condition, detected in 15-30% of hysterectomy specimens. It is characterized by the presence of endometrial glands and stroma within the myometrium. The data regarding incidence or incidental finding of adenomyosis in hysterectomy specimen is lacking despite this condition being common and bearing serious implications in symptomatology as well as in infertility. Adenomyosis can be incidental finding in hysterectomy done for other gynecologic pathology as well. Hence, this present study has established the prevalence of adenomyosis as well as it’s association with other uterine pathology in routine hysterectomy specimens. This was a cross sectional study conducted at Nepal Medical College and Teaching Hospital (NMCTH), Kathmandu for a duration of one year (March 2019 to February 2020). Total of 154 hysterectomies were included in the study, out of which 37 cases showed adenomyosis. The prevalence of adenomyosis was 24%. The age group for adenomyosis ranged from 36 years to 52 years with the mean age of 44 ± 4.4 years. The most common pathology other than adenomyosis was leiomyoma (19 cases) followed by two cases of endometriotic cyst, two cases of endometrial polyp, one case of high grade squamous intraepithelial lesion (HSIL), one case of hyperplasia of endometrium with atypia, and one case of serous cyst adenoma of ovary. Thus this study showed that the prevalence of adenomyosis was 24% and was seen higher in the age group of 35-50 years. The most frequent co-pathology in these adenomyosis cases was leiomyoma. 1Department of Pathology, 2Department of Obstetrics and Gynecology, Nepal Medical College and Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr Kricha Pande, Assistant Professor Department of Pathology, Nepal Medical College and Teaching Hospital Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: krichapande@gmail.com Orcid ID: https://orcid.org/0000-0002-9303-831X DOI: https://doi.org/10.3126/nmcj.v22i3.32629

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TL;DR: In this article, a hospital-based prospective observational study done in a tertiary hospital at Eastern Nepal over a period of Six months from August 2019 to January 2020 was conducted to see the acceptance of PPIUCD and study its related complications.
Abstract: The modern intrauterine contraceptive device (PPIUCD) is a safe, effective and long term reversible, coitus independent method of contraception with fewer side effects. The immediate postpartum insertion is considered to be an ideal time as patients need not have to return to the facility for the same. The aim of the study was to see the acceptance of PPIUCD and study its related complications. This is a hospital based prospective observational study done in a tertiary hospital at Eastern Nepal over a period of Six months from August 2019 to January 2020. All the women who delivered during the study period were counseled for family planning methods and those who opted for PPIUCD were enrolled. Data was validated and analyzed using SPSS version 17. Acceptance of PPIUCD in the study was only 6.3% despite the method being very effective, safe, long acting and reversible with fewer side effects. The main reason for declining the method being misbelief about the method and husband’s refusal. Forty percent of the acceptors were in the age group of 21-25 years and 33.6% of them were multigravida. Insertion was high in post placental vaginal delivery (61%) as compared to trans cesarean (28%). The main reason for removal was psychosocial aspects followed by pelvic pain and abnormal uterine bleeding. Few complications like UTI (4.4%), fever (4%) were noted during hospital stay and at three month follow up pelvic pain was the most common problem reported. Though the overall acceptance of PPIUCD is in rising trend but in this study it is very low. Awareness of the method, improving health education, active participation of the partner in the counseling process will definitely change the recent scenario. It should be incorporated in the government schemes like Safe Motherhood to cover the high unmet need of contraception in Nepal.

Journal ArticleDOI
TL;DR: SOFA and qSOFA both proved to be similar as a simple prognostic tool with discriminatory capacity in predicting prognosis in septic patient presenting to emergency department as a predictor of mortality among sepsis patients.
Abstract: There are many clinical scoring systems that measure the severity in sepsis and septic shock. Therefore, our study aims to calculate prognostic accuracy of commonly used scoring system SOFA and qSOFA in emergency department as a predictor of mortality among sepsis patients.This was prospective observational study conducted in an emergency department for a period of seven months. 156 patients were studied and descriptive statistical analysis was done. The most common source of infection was respiratory. A positive and moderate correlation was seen between initial SOFA score and qSOFA score. The AUC of SOFA score and qSOFA for predicting the mortality were 0.978 and 0.886 with sensitivity of 96.9% and specificty of 57% for SOFA and sensitivity of 96.9% and specificity of 76.1% for qSOFA.SOFA and qSOFA both proved to be similar as a simple prognostic tool with discriminatory capacity in predicting prognosis in septic patient presenting to emergency department. 1Department of General Practice and Emergency Medicine, 2Clinical Pharmacist, Nepal Medical College & Teaching Hospital, Attakhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Sameer Thapa Department of General Practice and Emergency Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshower-8, Kathmandu, Nepal Email: sams.thp@gmail.com Orcid ID: 0000-0002-0922-2289 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30025

Journal ArticleDOI
TL;DR: The present study concludes, lacto-vegetarians are physically fit compared to non-vegarian so as male compared to female.
Abstract: A pure vegetarian, consumes the food of plant origin, reportedly has lower risk of chronic diseases and may have enhanced athletic performance compared to omnivorous. Lactovegetarian consumes dairy products and plant-based foods where as lacto-ovo-vegetarians, being categorized as vegetarian, consumes egg as well. Considering vegan diet as healthy food habit and appropriate medication, world is directing towards vegan diet. Lacto-vegetarian and non-vegetarian participants were included in this study based on inclusion criteria from various streams; MBBS, BDS, CTEVT and a randomized cross-sectional study was performed among selected students and independent sample ‘t’ was used for analysis. Total enrolled participants (n=100), lacto-vegetarians (LV=50, male= 15, female=35) group and non-vegetarians (NV=50, male= 22, female=28) group were separated, age 16-27 years. Comparing the variables, result showed (NV=18.28±2.09, LV=19.14±1.43yrs, P=0.01), weight (NV=53.76±9.02, LV=50.16±4.82kg, P=0.01) and BMI (NV=29.63±4.49, LV=28.03±2.52kg/m2, P=0.03). Lacto-vegetarians reported greater exercise duration (NV=224.24± 52.13s, LV=248.50±42.33s, P=0.01) and physical fitness index score (NV=62.14±14.86, LV=72.41±16.80, P=0.002) which was statistically significant. Waist circumference (77.32±4.22, 70.48±3.95, P=0.00), hip circumference (86.97±3.7, 81.76±5.65, P=0.00), waist hip ratio (0.88 ±0.04, 0.86±0.05, P=0.01), exercise duration (263.51±43.5, 220.43±44.76, P=0.00) and physical fitness index score (74.03±14.42, 63.3±16.61, P=0.00) were significantly greater in male (n=37) than female (n=63). The present study concludes, lacto-vegetarians are physically fit compared to non-vegetarian so as male compared to female. 1Department of Physiology and 2Department of Anatomy, Nobel Medical College and Teaching Hospital, Biratnagar,

Journal ArticleDOI
TL;DR: It was seen that multiple oral manifestations were seen in patients undergoing hemodialysis, and this information can be used for designing effective intervention strategies to prevent and manage oral manifestations in adult he modialysis patients of Nepal.
Abstract: Oral cavity is the mirror of systemic health. Amongst various systemic diseases, Chronic Kidney Disease (CKD) is one such disease that presents with a spectrum of oral manifestations. The oral health care professionals need to attain a holistic approach to the management of patients with complex medical problems and should be in par with the changing technology and medical advances. Amongst all the systemic disorders, diseases of the renal system pose a major cause of morbidity and mortality worldwide, as the kidneys are vital organs for maintaining a stable internal environment. The plethora of oral manifestations observed in chronic renal failure and associated therapies are altered taste, gingival enlargement, xerostomia, various mucosal lesions like hairy leukoplakia, lichenoid reactions, ulcerations, angular chelitis, candidiasis etc. With growing awareness about the inter-relationship between dental and medical problems, the role of dentist has become pivotal in overall health care of patients with CKD and also to render services for the oral findings of such diseases. This information can be used for designing effective intervention strategies to prevent and manage oral manifestations in adult hemodialysis patients of Nepal. The objective of this cross sectional study was to see the oral manifestations in hemodialysis patients and their Knowledge and attitude towards Oral Health. Face to face interviews was done with the patients to gather knowledge regarding socio-demographic variables and tobacco history. Following statistical analysis, it was seen that multiple oral manifestations were seen in patients undergoing hemodialysis.

Journal ArticleDOI
TL;DR: There was a significant association between severity of glaucoma and pattern of visual field defect (p=0.000), and the superior hemifield was affected twice more than the inferior hem ifield in newly diagnosed cases of POAG.
Abstract: The purpose of this study was to evaluate the location and pattern of visual field defects as measured by Humphrey Field Analyzer (HFA 24-2) in newly diagnosed primary open angle glaucoma (POAG) attending tertiary care hospital. This was a cross sectional, descriptive study. One hundred and four eyes of 52 patients who fulfilled the inclusion criteria during one year were included. They were classified as mild, moderate and severe glaucoma according to severity. Paracentral scotoma in superotemporal and superonasal region was the most frequent visual field defect observed in mild glaucoma. Superior arcuate defect and double arcuate defect was commonly seen among moderate and severe stages of POAG respectively. There was a significant association between severity of glaucoma and pattern of visual field defect (p=0.000). The superior hemifield was affected twice more than the inferior hemifield in newly diagnosed cases of POAG.

Journal ArticleDOI
TL;DR: It could be concluded that opportunistic screening could be beneficial in detecting the cases and at least one screening in the lifetime of a women could be recommended.
Abstract: Cervical cancer is the most common cause of cancer deaths among the women in the developing countries. Every year in Nepal almost 3000 new cases are being diagnosed. Pap smear is one of the significant screening tests for reduction of incidence and mortality from cervical cancer but many developing countries failed to obtain high coverage of target population. So this study aimed to find out the prevalence of the cervical intraepithelial lesion in those areas which are remote through the heath camps. The cross-sectional study was done in the Thokarpa Gaupalika of Sindhupalchowk District where 173 females were screened with Pap smear for cervical cancer. Among them, 99 (57.2%) had normal findings and 42 (24.2%) had benign inflammatory changes. The Squamous Intraepithelial Lesion (SIL) was seen in 10.4% of the screened population. Majority of the SIL cases were found to have low grade squamous intraepithelial lesion (LSIL) 6.35% and 4.04% cases were of the high grade intraepithelial lesion (HSIL). Carcinoma cervix was rare and seen in only one case among the screened population. Hence, it could be concluded that opportunistic screening could be beneficial in detecting the cases and at least one screening in the lifetime of a women could be recommended. Department of Obstetric and Gynecology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Astha Shrestha Lecturer, Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal. Email: drasthashr57@gmail.com Orcid ID: 0000-0001-6303-9963 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30035

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TL;DR: The neonates with clinical features had positive correlation with abnormal laboratory parameters with statistically significant p value, suggesting that septic neonates showed abnormal laboratory Parameters, which emphasizes the role of laboratory parameters other than blood culture for the diagnosis and empirical treatment of neonatal sepsis.
Abstract: Neonatal sepsis is a common reason for neonatal morbidity and mortality. Only clinical manifestations are inadequate to diagnose neonatal sepsis. In context of Nepal, there has been few studies correlating bacterial and clinical profile but none till now has managed to define the most adequate parameters to diagnose neonatal sepsis with certainty. Hence, this study is conducted to describe and compare clinical and laboratory characteristics of culture positive and clinically suspected sepsis (blood culture negative) and then assess whether differences exist between them. A descriptive prospective study was carried out for a period of one year starting from April 2017 to March 2018 at the NICU of Kathmandu Medical College. A total of 129 culture proven and suspected septic neonates were included. Clinical features, septic screening including blood culture, biochemical tests and radiological findings were taken into consideration. The incidence of definite neonatal sepsis was 22.4%. The most common bacterial isolates were gram negative bacteria. Klebsiella spp (48%) followed by CoNS (17%), Acinetobacter spp (14%), Enterobacter spp (7%), Pseudomonas (7%) and Staphylococcus aureus (7%) were isolated. Different non specific clinical features like respiratory and gastro-intestinal symptoms were seen. The neonates with clinical features had positive correlation with abnormal laboratory parameters with statistically significant p value, suggesting that septic neonates showed abnormal laboratory parameters. This data emphasizes the role of laboratory parameters other than blood culture for the diagnosis and empirical treatment of neonatal sepsis. Department of Pediatrics, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal Corresponding author Dr Anup Shrestha Lecturer, Department of Pediatrics, Kathmandu Medical Collage and Teaching hospital. Email: anupsrestha@gmail.com Orcid ID: 0000-0002-1872-6497 DOI: https://doi.org/10.3126/nmcj.v22i1-2.30046

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TL;DR: It is concluded that food consumption pattern play a critical role in the incidence of Gastric cancer and dietary modification to reduce salt and salted food is a practical strategy with which gastric cancer risk can be prevented in these high risk ethnic group of Nepal.
Abstract: Gastric cancer is the fourth most frequently occurring malignancy, after lung, breast and colorectal cancer, and the second most common cause of death from cancer worldwide. The global incidence of gastric cancer shows wide geographic variation with a 15-20 fold difference between high and low incidence region. Therefore the prevention of gastric cancer represents one of the most important aspects of any cancer control strategy around the world. From the hospital based data in Nepal gastric cancer is the third most common cancer in males and the sixth common cancer in females. An observational hospital based descriptive study was carried out in the Oncology Unit of (NMCTH) from 2013-2018 on relationship between salty processed food consumption and increased possibility of development of gastric cancer in different ethnic groups of Nepal. Fifty-four diagnosed gastric cancer patients were enrolled and their dietary habits were extensively looked into. Of these 55.6% (30) were males and 44.4% (24) were females. The patient’s age ranged between 25-75 years and the peak incidence was in age group 41-60 years. The habit of consumption of smoked meat was higher (77.8%) than the consumption of packed food and fermented food. Tibeto-mongoloid ethnicity was found to have more prevalence (64.8%) to gastric cancer. The common site of presentation of gastric cancer was at the antrum (44.4%) and tubular adenocarcinoma was the most common type. It was the Tibeto-mongoloids whose food habit pattern comprised of major consumption of salty processed food and having more preference for salty processed food in daily life had increased high risk of gastric cancer than the other ethnic groups. This concludes that food consumption pattern play a critical role in the incidence of gastric cancer and dietary modification to reduce salt and salted food is a practical strategy with which gastric cancer risk can be prevented in these high risk ethnic group of Nepal. 1Clinical Oncology Unit, Department of Medicine, 2Forensic Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Rashmey Pun, Consultant Clinical Oncology Unit, Department of Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: dr.rpun@gmail.com ORCID ID: https://orcid.org/0000-0002-1743-2147 DOI: https://doi.org/10.3126/nmcj.v22i3.32633

Journal ArticleDOI
TL;DR: Optimum use of fine needle aspiration cytology (FNAC) and better understanding of cytomorphological characteristic of thyroid lesions by using Bethesda system, triaging of patients who are to be treated medically or surgically is more accurate.
Abstract: More than 50% of the world’s population has at least a thyroid nodule. Detail clinical examination and radiology may help in diagnosing thyroid lesions but the management depends upon the cytopathological diagnosis. Optimum use of fine needle aspiration cytology (FNAC) and better understanding of cytomorphological characteristic of thyroid lesions by using Bethesda system, triaging of patients who are to be treated medically or surgically is more accurate. The objective of this present study is cytopathological evaluation of thyroid lesions based on Bethesda System in patients attending Birat Medical College and Teaching Hospital. The objective was also to correlate the cytological findings with histopathological findings where ever possible. A total of 104 patients with thyroid lesions underwent fine needle aspiration cytology in a period of a year (September 1, 2019 to August 31, 2020). Cytological features were evaluated and classified according to the Bethesda system. Histopathological features were evaluated and correlated wherever available. Among 104 patients with thyroid lesions 93 were female and 11 were male. Four cases turned out to be non diagnostic, 85 benign, three Atypia of undetermined significance, three Suspicious for follicular neoplasm and eight Suspicious of malignancy and one Malignant according to Bethesda system. Histopathology specimen was received in 31 patients out of whom 20 (64.5%) patients were reported as colloid nodule, two follicular adenoma, one Hurthle cell adenoma, six papillary carcinoma and two follicular carcinoma. Medullary carcinoma and anaplastic carcinoma were not seen in the patients evaluated. Specificity and sensitivity of fine needle aspiration cytology was 94.7% and 88.9% respectively. Thus reporting thyroid lesions FNAC with Bethesda system allow a more specific cytological diagnosis.

Journal ArticleDOI
TL;DR: Ropivacaine is a safe drug providing longer duration of sensory analgesic effect and early recovery of motor function with good operating conditions for forearm surgeries under brachial blexus block.
Abstract: Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects.Therefore this study was conducted to assess the block characteristics and side effects of 0.75% ropivacaine in axillary brachial plexus block for forearm surgeries. This interventional study was carried out in 30 patients of ASA physical status I or II, aged 18 to 60 yrs undergoing elective surgery u nder axillary brachial plexus block with 20 ml of 0.75 % Ropivacaine using ultrasound and nerve stimulator. The mean onset time of sensory block was 4.53 ± 1.18 minutes and duration of sensory block was 491.00 ± 57.45 minutes. The mean onset time of motor block was 9.17 ± 1.39 minutes and duration of motor block was 452.50 ± 52.34 minutes. The mean time for rescue analgesia or total analgesic effect was 569.47 ± 88.46 minutes. No patients developed any side effects. The result of this study concluded that Ropivacaine is a safe drug providing longer duration of sensory analgesic effect and early recovery of motor function with good operating conditions for forearm surgeries under brachial blexus block.