Showing papers in "Nepal Medical College journal in 2021"
TL;DR: Interestingly, observations either compared to (lamina, uncinate process, anteroposterior diameter of spinal canal and Torg’s ratio) or were larger (Pedicle and spinous process) than the Indian study with pedicle axis length being largest among all the compared studies.
Abstract: There is paucity in literature describing the morphology of sub-axial vertebra of the local population. Available studies are limited to the body, intervertebral disk, spinal canal and Torg’s ratio of the cervical vertebra. Therefore, the present study aims to document various morphological parameters of sub axial vertebra. Sixty-four dry sub-axial vertebrae of the Nepalese population were studied using Vernier Calipers calibrated to 0.1 mm accuracy. Paired parameters of pedicle, lamina, uncinate process, the distance of the apex of the uncinate process to intervertebral foramen and foramen transversarium were measured. Similarly, unpaired parameters including spinous process length, vertebral foramen anteroposterior width, vertebral foramen transverse diameter and Torg’s ratio were evaluated. Except the height of left lamina of C3 to C6 vertebrae, none of the parameters showed significant side differences. Significant higher values of C7 were noted against C3-C6 on vertebral body height, vertebral body anteroposterior diameter, spinous process length and vertebral foramen anteroposterior diameter. Population data of sub-axial vertebra available in literature showed mixed results with ours. Interestingly, our observations either compared to (lamina, uncinate process, anteroposterior diameter of spinal canal and Torg’s ratio) or were larger (Pedicle and spinous process) than the Indian study with pedicle axis length being largest among all the compared studies. The information of this study may be used as a reference database for our local setting and could be of value in preoperative planning and in designing implants. 1Department of Anatomy, Birat Medical College, Tankisinwari, Biratnagar, 2Department of Orthopedics and Trauma, HAMS hospital, Dhumbarahi, 3Department of Anatomy, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, 4Department of Anatomy, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal Corresponding author
3 citations
TL;DR: The ISS used in the study might be suitable in the context of Nepalese population, however, further similar studies on large number of patients with multiple allergens are required to determine the exact number of contact allergens prevalent in the authors' population.
Abstract: Allergic contact dermatitis (ACD) is one of the most common diseases presenting to the Dermatology department. The one and only method of preventing as well as treating this disease is avoidance of the allergen causing it. The identification of the allergen causing the ACD is possible by performing patch testing. The purpose of this study was to identify common allergens among patients with ACD using Indian standard series (ISS) of patch test. Clinically suspected cases of ACD were included in the hospital based cross-sectional study from January to December 2017. These cases underwent patch testing with the ISS. The study assessed the following variables: sex, age, occupation, site and positive patch test results. There were a total of 58 patients among which, 36.2% were males and 63.8% were females with a mean age of 32.36±12.51 years. Positive patch test reactions were seen in 63.0% of patients. The most common allergens were nickel sulphate (51.4%), fragrance mix (37.8%), potassium dichromate (8.1%), colophony (8.1%) and black rubber mix (8.1%). Among male, most common allergens were fragrance mix (57.1%), nickel sulphate (28.6%) and potassium dichromate (21.4%) while in female, most common allergens were nickel sulphate (65.2%) and fragrance mix (26.1%). In our study, majority of the allergens were positive. Hence, the ISS used in the study might be suitable in the context of Nepalese population. However, further similar studies on large number of patients with multiple allergens are required to determine the exact number of contact allergens prevalent in our population. Department of Dermatology and Venereology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Arnija Rana Department of Dermatology and Venereology, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: arnija.ajju@gmail.com Orcid No: https://orcid.org/0000-0003-1149-7158 DOI: https://www.doi.org/10.3126/nmcj.v23i1.36222
3 citations
TL;DR: This study shows that Evan's Index was higher in individuals who were 60 years and above in both males and females, and the very small standard deviations appreciated in the result suggest that Evan’s index can be calculated fairly accurately.
Abstract: Ventriculographic indices are obtained by using Evan’s Index. Evan’s Index is a ratio which compares the maximum width of the frontal horns of the lateral ventricle to the maximum transverse diameter of the inner table of the skull and serves as an indirect marker of ventricular volume. Evan’s Index has been extensively used in the diagnosis of idiopathic normal pressure hydrocephalus, in the assessment of outcome of patients having shunt placement which is the primary mode of treatment. This study was aimed to find out the normal values of Evan’s Index on brain CT scan in individuals attending Nepal medical college teaching hospital, Kathmandu, Nepal. A total of 500 individuals CT (250 males and 250 females) were finally selected. The ages were ranged between 5 to 80 years old. The mean Evan’s Index in the studied population was 0.253 ± 0.037 in males, 0.250 ± 0.034 in the females and an overall mean of 0.251 ± 0.035. There was no significant statistical difference in the Evans ratio between male and females (P = 0.274). This study shows that Evan’s Index was higher in individuals who were 60 years and above in both males and females. The very small standard deviations appreciated in the result suggest that Evan’s index can be calculated fairly accurately. Department of Anatomy, Nepal medical college teaching hospital, Kathmandu, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Allin Pradhan, Assistant professor, Department of Anatomy, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: meallinsh@gmail.com Orcid No: https://orcid.org/0000-0002-7691-2335 DOI: https://www.doi.org/10.3126/nmcj.v23i1.36227
3 citations
TL;DR: It is suggestive of that coliform bacterium detected in roof-harvested rainwater throughout Anguilla poses a potential health risk to the consumers and requires proper treatment for consumption.
Abstract: Anguilla is a dry to semi-arid island in the Caribbean where the majority of residents rely on roof-harvested rainwater. The objective of this study was to assess the presence of indicator coliform bacteria and associated health risk to the consumer in Anguilla. Rooftop rain water harvested samples were collected from 86 homes. Bacterial count was done by membrane filtration and culture on Difco Modified mTEC Agar and Hach m-ColiBlue24 agar. Bacteria grown on agar plates were counted by using darkfield colony counter. All owners or residents were interviewed for water use related gastroenteritis. Coliform bacteria were grown in 88.4% (76/86) samples with very few colonies to confluent growth of fecal E. coli, non-fecal E. coli and coliform other than E. coli. Results indicated that the majority of the samples contain the mixture of different coliform bacteria. Household survey revealed the majority of the households drink unpotable roof harvested rain water without any treatments and have the history of at least one episode of gastroenteritis-like illness during the past year. Our result is suggestive of that coliform bacterium detected in roof-harvested rainwater throughout Anguilla poses a potential health risk to the consumers and requires proper treatment for consumption. 1Department of Microbiology and Immunology, American University of Barbados School of Medicine, Wildey, Saint Michael, BB 14007 Barbados and 2Department of Microbiology, Saint James School of Medicine, Anguilla, BWI Corresponding author Dr. Birendra Raj Tiwari, Department of Microbiology and Immunology, American University of Barbados School of Medicine, Wildey, Saint Michael, BB 14007 Barbados; Email: tiwari.birendra58@gmail.com Orcid ID: https://orcid.org/0000-0003-4654-8197 DOI: https://www.doi.org/10.3126/nmcj.v23i1.36235
1 citations
TL;DR: Clinical efficiency of non-contact infrared thermometer is less than that of axillary digital thermometer and mercury in glass thermometer in febrile patients and non- Contact infra-red thermometer has lower predictability in both upper and lower body temperature range.
Abstract: Fever is defined as rise in normal body temperature above 98.6°F. Clinical thermometer is a medical instrument for measuring human body temperature. The traditionally used mercury in glass thermometer was replaced by digital thermometer due to mercury toxicity. Noncontact infra-red thermometer is a non-invasive thermometer used for un-cooperative pediatric patients. The objective of this study is to determine the clinical efficiency of non-contact infrared thermometer over axillary digital thermometer and mercury in glass thermometer over a range of body temperature by using paracetamol in febrile patients. This descriptive hospital based cross sectional study was conducted from 5th December 2019 till 23rd August 2020 after ethical approval from Institutional Review Committee of Nepal Medical College and Teaching Hospital. Mercury in glass thermometer, axillary digital thermometer and non-contact infrared thermometer were used to measure body temperature in febrile patient. Body temperature was re-measured one hour after administration of paracetamol. Data was entered and analyzed with statistical package for social sciences version 16. Axillary digital thermometer has high predictability in the upper body temperature range (in febrile state) but its predictability is low in lower body temperature range (our normal body temperature). Non-contact infrared thermometer in comparison with axillary digital thermometer has lower predictability in both upper and lower body temperature range. Clinical efficiency of non-contact infrared thermometer is less than that of axillary digital thermometer and mercury in glass thermometer in febrile patients. 1Department of Pharmacology, 2Department of Pediatrics, 3Department of Surgey, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, 4Department of Biochemistry, Maharajgunj Medical Campus, Kathmandu,
1 citations
TL;DR: Assessment of health seeking behavior of the people regarding complementary and alternative medicine (CAM) in remote area Dhudhakaushika, Gaunpalika of Solukumbu District during April – August 2017 found CAM use especially self-treatment with medicinal plants was found to be a common practice along with modern medicine in a rural setting in Nepal.
Abstract: The objective of the study was to assess the health seeking behavior of the people regarding complementary and alternative medicine (CAM) in remote area Dhudhakaushika, Gaunpalika of Solukumbu District during April – August 2017. The sample size was 300 (129 male and 171 female). Semi-structured question was design and Focus Group Discussion (FGD) was conducted. The results indicated that about three fourths of the respondents visited a modern medical institution 224 (74.7%), a little under one-half 129 (43.0%) visited Dhami-Jhakri and 85 (28.3%) contacted the Jharphuke who chanted a Mantra over a sick adult or child. Around 33 (11.0%) contacted the female community health volunteer (FCHV), 20 (6.7%) used domestic medicine or ethnomedicine, 13 (4.3%) visited a pharmacy and 9(3.0%) visited a private allopathic clinic when they felt discomfort. Respondents ascribed the cause of the disease to supernatural causes or evil spirits (53.3%), to germs (48.7%), curse of God (83.0%) to sins committed in the past (10.3%), and other causes (5.7%). The respondents usually consulted at first Dhami-Jhakri (43.0%) and Jharphuke (28.3%) when they fell sick. People utilized CAM in order to relieve undesired pain, uneasiness in the body and restore the health condition. The types of alternative medicine utilized by the respondents were Ayurveda 162 (54.0%), jadi-booti 248 (82.7%), homeopathy 94 (31.3%), relaxation 33 (11.0%), and meditation 68 (22.7%) healing touch 55 (18.3%), therapeutic massage 109 (36.3%), acupuncture 126 (42.0%), acupressure 44 (14.7%) Yoga 28 (3.3%) and 10 (3.3%) did not know any practice other than Dhamijhakri. Through the FGD, it was observed that traditional medicine sector was an important source of health care in Solukhumbu. The main reasons for consulting a CAM healer were the proximity, affordable barter system, availability, family pressure and the strong opinion of the community. In conclusion, CAM use especially self-treatment with medicinal plants was found to be a common practice along with modern medicine in a rural setting in Nepal. The study findings emphasized the reality of multiple recourse adopted by health care seekers and their deeply entrenched belief in CAM. Nepal has a very rich tradition in the use of medicinal plants for the treatment of various ailments. This may indicate the need for the integration of the modern and CAM systems in terms of evidence-based information sharing. This calls for bringing CAM healers into the mainstream by providing them with proper training, facilities and referral services. The healers can motivate the persons to access modern health care services by placing a Tika of ash (Kharani) prior to referral. A positive interaction between the two systems has to be harnessed to work for the common goal of improving health of the people. Department of Community Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8,
1 citations
TL;DR: LH is a safer and better alternative to OH for management of pediatric inguinal hernia when comparing post-op pain and hospital stay and duration of surgery and cost for the procedure favor OH at present in this setup.
Abstract: Repair of inguinal hernia is one of the most commonly performed pediatric surgical procedures. The standard of treatment has been open herniotomy (OH). Recent trends have shown promising results with use of laparoscopy (LH) for the same. The aim of this study was to compare laparoscopic herniotomy with the standard of care at the time of the study, which has become an increasingly common procedure at our center. This was a prospective follow-up study conducted at the Department of Surgery at Nepal Medical College and Teaching Hospital. A total of sixtyfour patients who underwent herniotomy were included in the study and followed up for a total duration of two years post-operatively. Immediate post-op pain was assessed with the use of visual analogue scales. Complications, recurrence, and metachronous herniation were noted in the follow up visits. Use of laparoscopy resulted in a longer operative time (36.68 min vs 22.5 min for OH, P <0.001). Pain scores were similar at immediate post-op period (LH 4.18 vs OH 3.93) but decreased significantly for LH compared to OH at 6 hours (3.68 vs 4.31, P = 0.018), 12 hours (2.71 vs 3.62, P <0.001), and 24 hours (2 vs 3.03, P <0.001). Difference in the mean hospital stay was statistically significant (LH 2.02 days vs OH 2.34 days, P <0.001). No recurrences occurred during the follow up period of the study. No patients developed contralateral metachronous hernia during the follow-up period. The cost of OH compared to LH was significantly less. LH is a safer and better alternative to OH for management of pediatric inguinal hernia when comparing post-op pain and hospital stay. However, duration of surgery and cost for the procedure favor OH at present in our setup. Department of Surgery, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr. Giridhar Bahadur Nhuchhe Pradhan, Associate Professor, Department of Surgery, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Email: gbnpradhan@gmail.com Orcid No: https://orcid.org/0000-0003-3183-1555 DOI: https://www.doi.org/10.3126/nmcj.v23i1.36229
1 citations
TL;DR: Early collection and analysis of tear sample can yield maximum positive results therefore tear film could be one of the modes of transmission of SARS-CoV-2 virus.
Abstract: Researchers in 2004 found that tear flim can be one of the modes of transmission of SARS-CoV. Considering the fact that SARS-CoV-2 is similar to SARS-CoV, it is speculated that there may be a risk of transmission through tear flim in patients with COVID-19. Therefore, this study was conducted to understand whether COVID-19 viral genome is present in the tear film or not. It was a cross-sectional quantitative study done in Kathmandu Medical College Teaching Hospital, Duwakot. Tear sample collection was done using schirmer’s strip and conjunctival swab of confirmed COVID-19 positive admitted cases and then the sample was sent for viral genome analysis. Especially designed proforma was used for recording the patient demographics, history, clinical examination findings and investigations results. Data were analyzed using the Statistical Package for the Social Sciences (version 21) and expressed in frequency, percentage and mean. Out of 30 enrolled patients, 23.3% (n=7) showed positive results in tear RT-PCR test for SARSCoV-2. Among them, 85.7% (n=6) had positive tear sample RT-PCR on the very first day of sample collection with their CT value in tear sample ranging from 30-35. Patients who were positive were mostly in the age group of 21-30 years (71.4%) and were local vendors by occupation (71.4%). However, none of the patients had any ocular symptoms. Tear sample analysis with RT-PCR showed 23.3% positivity for SARS-CoV-2. Early collection and analysis of tear sample can yield maximum positive results therefore tear film could be one of the modes of transmission of SARS-CoV-2 virus. 1Department of Ophthalmology, 2Department of Microbiology, Kathmandu Medical College, Sinamangal, Kathmandu,
TL;DR: The study demonstrated that the thickness of subcutaneous fat at the site of incision is a good predictor of superficial incisional SSI following open appendectomy and the risk of superficial wound site infection increases as the thickness in SCFT at the sites of incison increases.
Abstract: Obesity is a known risk factor for surgical site infection (SSI). Recent studies have demonstrated that fat burden at the incisional site rather than body mass index (BMI) is a more precise and sensitive measure to predict the risk of SSI. The purpose of the study was to evaluate the correlation between subcutaneous fat thickness (SCFT) at the level of Mc Burney’s point and the occurrence of superficial incisional SSI among the patients undergoing open appendectomy. A total of 120 patients who underwent open appendectomy were included in the study. SCFT was measured preoperatively with ultrasonography (USG). The occurrence of superficial incisional SSI was evaluated in relation to SCFT. Previously identified well established risk factors for the development of SSI were also considered by the study. Statistical analysis was performed using SPSS version 17. Overall, superficial incisional SSI was observed in 27 (22.5%) participants. Mean SCFT at the level of Mc Burney’s point among male and female population was 2.26 cm ± 0.74 (SD) and 2.02 cm ± 0.83 (SD) respectively. Patients with superficial incisional SSI had a mean fat thickness of 2.80 cm and those without SSI had mean fat thickness of 1.97 cm. The difference in SCFT was statistically significant (p=.001). More interestingly, the area under the ROC curve was more for SCFT, in comparison to BMI among the patients who developed superficial incisional SSI (81% vs. 73%). Furthermore, we analysed the occurrence of superficial incisional SSI with SCFT cut off at 2.80 cm, which was statistically significant. As majority of the study population were young adults, risk factors like smoking, diabetes mellitus and nutritional status failed to demonstrate significant correlation with post appendectomy wound site complications. The study demonstrated that the thickness of subcutaneous fat at the site of incision is a good predictor of superficial incisional SSI following open appendectomy and the risk of superficial wound site infection increases as the thickness of subcutaneous fat at the site of incision increases. Department of Surgery, Nepal Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu,
TL;DR: The seroprevalence of T. gondii infection among HIV/AIDS patients in Nepal is studied and this report constitutes the first report from Nepal.
Abstract: Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii affecting about one third of the world’s population. It can be asymptomatic to fatal toxoplasmic encephalitis depending on the immune status of infected individuals. Among HIV/AIDS patients, it usually manifest as lifethreatening condition. We, therefore, studied the seroprevalence of T. gondii infection among HIV/AIDS patients in Nepal and this report constitutes the first report from Nepal. A total of 45 HIV/AIDS patients were included in this study. The serum samples collected and stored at -20°C were tested for Toxoplasma IgG and IgM antibodies at National Public Health Laboratory, Teku, Kathmandu using Snibe Maglumi 1000 Fully Automated Immunoassay Analyzer and the results were expressed in AU/ml. The blood put into the EDTA tube was used for CD4 count using BD FACS Calibur Flow Cytometer. In this study, 33.3% (15/45) HIV infected patients were seropositive for anti-T. gondii IgG. However, none of them were positive to antiT. gondii IgM. Most of the patients (36 out of 45 patients) had <200/mm3 CD4 cell count. However, out of them 36.1% (13/36) were seropositive to anti-T. gondii IgG whereas 22.2% (2/9) patients with ≥200 CD4 cell counts had Toxoplasma antibodies (p >0.05). 1ShiGan International College of Science and Technology, Narayangopal Chok, 2Sukraraj Tropical & Infectious Disease Hospital, Teku, 3HIV Reference Unit, National Public Health Laboratory, Teku, 1,4Nepal Medical College and Teaching Hospital, Attarkhel, Gokarneswor-8, Kathmandu, Nepal
TL;DR: A 30 years old lady presented with lump in her both breasts and generalized lymphadenopathy but IHC was in favour of melanoma, and the final diagnosis was cutaneous melanoma of trunk with atypical presentation.
Abstract: Melanoma is one of the aggressive malignancy arising from the melanocyte. Melanoma usually occurs in the mucus membrane and choroid. There are few cases who may present with lymph node, breast and other involvement. However, few may have an atypical origin and rarely the origin may be unknown. Its aggressive presentation, diagnosis and prognosis sometimes is very challenging to the physician. The mainstay of the diagnosis remains the histopathology and immuno-histochemistry (IHC). Varieties of treatment have evolved from surgical excision to systemic chemotherapy and immunotherapy with promising result, the treatment is still challenging. A 30 years old lady presented with lump in her both breasts and generalized lymphadenopathy. Excisional biopsy revealed Diffuse large B cell Non Hodgkin lymphoma (NHL) but IHC was in favour of melanoma. The final diagnosis was cutaneous melanoma of trunk with atypical presentation (generalized lymphadenoapthy and bilateral breast metastasis). 1Department of Oncology, Banga Bandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 2National Academy of Medical Sciences, Mahaboudha, Bir Hospital, Kathmandu, Nepal.
TL;DR: Investigation of the effectiveness of closed reduction of nasal bone fracture according to severity found that closed reduction with good alignment is the preferred method and Septorhinoplasty and extracorporeal septoplasty should be applied in difficult and comminuted nasoseptal fracture.
Abstract: This study was conducted to investigate the effectiveness of closed reduction of nasal bone fracture according to severity. It was a retrospective study carried on 60 patients with mean age of 30.2 years (range 10-67 years) who have undergone a closed reduction of a nasal bone fracture at Gandaki Medical College Teaching Hospital from January 2017 to December 2019. The patient with nasal bone fracture who underwent surgical intervention with closed reduction under General anaesthesia were included in this study. Fracture severity was evaluated according to Hwang et al.’s classification method. All patients underwent closed reduction with external nasal splinting under General anesthesia. The patients were followed-up for at least three months to assess the complications, such as fracture recurrence and functional abnormality in the Department. The most common cause of nasal bone fracture was road traffic accidents 25 (41.6%) followed by physical assaults 18 (30%), fall injuries 12 (20%), other incidences 3 (5%), and industrial accidents 2 (3%). Forty-three (72%) cases underwent closed reduction within 24 hours of those who arrived within 4-6 hour of nasal injury in the hospital and the remaining 17 (28%) cases were reduced after 5 days of trauma. Concurrent fracture found in 8 (13%) cases and it included maxillary, zygomatic, orbital, frontal bone fracture. Nasal bone fracture mostly occurs in road traffic accidents. Closed reduction with good alignment is the preferred method. Septorhinoplasty and extracorporeal septoplasty should be applied in difficult and comminuted nasoseptal fracture. Department of Otolaryngology & Head and Neck Surgery, Gandaki Medical College, Pokhara, Nepal Corresponding author Dr. Brihaspati Sigdel, Associate Professor & HOD Department of Otolaryngology & Head and Neck Surgery, Gandaki Medical College, Pokhara, Nepal Email: brihassig1@gmail.com Orcid No: https://orcid.org/0000-0002-8546-6699 DOI: https://www.doi.org/10.3126/nmcj.v23i1.36225