bluuebunny/crossref_metadata_2025 huggingface dataset:
AWARENESS OF RISK FACTORS OF CARDIOVASCULAR DISEASE AMONG PATIENTS WITH DIABETES MELLITUS ATTENDING DIABETIC CLINIC OF BP KOIRALA INSTITUTE OF HEALTH SCIENCES
Authors: Khanal Dina , Parajuli Pushpa , Mehta Ram Sharan , Mandal Gayanand
Published: May 2022

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Aware­ness of risk factors of CVD is the first step towards effective preventive strategies to combat the CVD burden in diabetes patients. This study aimed to assess the awareness of risk factors of CVD among patients with diabetes mellitus attending diabetic clinic of B.P Koirala Institute of Health Sciences (BPKIHS).
Methods: A cross- sectional study was conducted among 112 patients with diabetes in diabetic clinic of BPKIHS. Convenient sampling was used for data collection over duration of six weeks using interview schedule by HDFQ II tool. The data were analyzed in the statistical package for social sci­ence software (SPSS) 16 versions and analyzed using descriptive and inferential statistics.
Results: Majority of respondent were aware about common risk factors such as (83.9%) smoking, (78.6%) physical activity, (75%) increasing age, (75.9%) high blood pressure, (71.4%) overweight respectively. Whereas most of the respondents were not aware about high cholesterol, fatty diet, preventive strategies and association of diabetes with CVD. Awareness was statistically significant with educational status, monthly income, residence, CVD information received and co-morbid condition as a heart disease.
Conclusions: Based on finding most of the respondents were aware about common risk factor even though they have inadequate level of awareness on overall risk factors of CVD among the risk factor they were poorly aware about cholesterol, gender and preventive aspect. So Effective education on diet and appropriate preventive strategies of CVD are indeed important to reduce CVD burden in diabetes patients.
SPECTRUM OF BREAST DISEASES IN A RURAL HIMALAYAN REGION OF WESTERN NEPAL: A HOSPITAL BASED STUDY
Authors: Devkota Harihar , Menyangbo Suryaman , Amgain Kapil
Published: May 2022

Background: Breast diseases, among the most common diseases in females occur in various pat­terns from benign to malignant. Their identification is crucial as some of the benign disorders pose threat to turn into malignancy. This study was aimed to determine the spectrum of breast diseases.
Methods: This was a hospital based retrospective study among all the patients in General Surgery OPD of Karnali Academy of Health Sciences, Teaching Hospital, diagnosed with breast diseases during one year period from August 2019 to July 2020 AD. Data were extracted and entered in SPSS version 16 for further analysis.
Results: Out of 110 cases, only 4 (3.96%) were male. Almost half 54 (49.09%) of the cases were in the age group of 21-30 years. Fibrocystic disease, Breast Abscess and fibroadenoma, and cracked nipple were 39 (35.45%), 38 (34.54%, 15 (13.63%) and 8 (7.28%) respectively. The benign diseases were seen mostly in the younger population while malignant breast diseases were seen in the older population. Mastalgia was mostly seen in the twenties (17.3%) and the thirties (10%) while Breast abscess was commonly encountered in the twenties (16.4%) and the teens (11.8%). The gynaecomastia were seen only in four males.
Conclusions: Fibrocystic breast diseases, Mastitis with or without abscess, fibroadenoma and cracked nipples were the first four most common breast diseases in females. The younger popula­tion had predilection towards the benign diseases which occurred most frequently in the third decade while the malignant occurred in sixth and seventh decade.
STUDENTS’ PERCEPTION ON EDUCATIONAL ENVIRONMENT OF THE POSTGRADUATE PROGRAMME IN SELECTED NURSING COLLEGES OF NEPAL
Authors: Bista Archana Pandey , Sharma Kalpana , Tamrakar Neeta , Sharma Muna , Bhattarai Tilrupa
Published: May 2022

Background: Student’s positive perception towards the academic environment determines the quality of education. This study aimed at finding students’ perception on educational environment of the postgraduate nursing programme of Nepal.
Methods: Descriptive cross-sectional design was conducted among 104 masters level nursing students from four selected nursing campuses under Institute of Medicine, Tribhuvan University. Enumerative sampling technique was used to select the sample. Data were collected using validated standard tool Dundee Ready Educational Environment Measure (DREEM) scale and analyzed using descriptive statistics.
Results: Most of the nursing students (81.7%) had positive level of perception on their educational environment and few had excellent perception. Total DREEM mean score was 134.37± 21 out of 200. Specifically, mean score of learning was 31.93 ± 5.1 out of 48, students’ perception of teachers was 30.02 ± 5.072 out of 44; students’ academic self-perception was 22.32 ± 3.54 out of 32; students’ perception of atmosphere was 32.26±5.1 out of 48 and mean score for students social self-perception was 17.82± 3.3 out of 28. Lower mean score < 2.0 was identified on teaching factual learning, opportunities to memorize learning, supporting during stress, time management of programs, well preparation for classes and student’s self-perception.
Conclusions: The findings indicate more positive perception on educational environment among postgraduate nursing students. Still some aspects such as teaching factual learning, memorizing learning, supportive students during stress, and social environment need to be emphasized to enhance the students’ educational environment of post-graduate nursing program by the academic institution.
INITIATION OF CONTACT TRACING FOR COVID-19 AT AN ACADEMIC INSTITUTION FOR HEALTH SCIENCE: INITIAL EXPERIENCES
Authors: Paudel Rajan , Upadhyaya Dipak Prasad
Published: May 2022

Transmission of COVID-19 cases has been found in clusters and sporadic form in different parts of Nepal, which swiftly strained the healthcare system. Contact tracing is a strategy to prevent further transmission of the COVID-19. It reduces the overwhelming burden in a health system. Academic institutions are the best alternative in contact tracing, not only in terms of task shifting but their training in epidemiology and research also best suits them. Besides, they can also train the health workers assigned for contact tracing in rural and urban settings. Multi-sectoral involvement from academia, community health workers, and effective information flow are instrumental for effec­tive contact tracing in resource-limited settings.
ASSOCIATION BETWEEN SLEEP DURATION, SLEEP QUALITY AND BODY MASS INDEX IN MEDICAL STUDENTS
Authors: Maharjan Niroj , Karki Prabin Kumar , Adhikari Bijaya , Bhaila Archana , Shrestha Hari
Published: May 2022

Background: Medical students are normally under extreme pressure due to the vast syllabus they have to cover within few years of their student life. The stress due to academic pressure and sudden change in lifestyle tend to affect their sleeping habits, which is considered as one of the potential risk factors for obesity. This study aimed to observe the association between sleep duration, sleep quality and body mass index in medical students.
Methods: This is a cross-section study conducted among 269 medical students. Self-reported sleep duration was noted, sleep quality was assessed with Pittsburgh Sleep Quality Index (PSQI) ques­tionnaire. Height in cm and weight in kg was recorded and BMI was calculated. The data obtained was divided into different groups according to sleep duration, sleep quality and BMI. ANOVA and independent t-test was done using Statistical Package for the Social Sciences version 25 for statisti­cal analysis. p< 0.05 was considered statistically significant.
Results: In general, 24 (8.9%) of students were underweight, 187 (69.5%) had normal weight, 51 (19%) were overweight and 7 (2.6%) were obese. 94 (34.9%) students reported to spent <7 hours in bed and 98 (36.4%) students had poor sleep quality. Mean BMI was significantly higher in students with short sleep (p-value=0.001, ANOVA) and in students with poor sleep quality (p-value=0.000, independent t-test).
Conclusions: Higher BMI was observed in the group of students having poor sleep quality and short sleep duration. Furthermore, poor sleep quality was more prominent in women than in men.
PERINATAL OUTCOME IN ADOLESCENT PREGNANCY: A RETROSPECTIVE STUDY AT KARNALI ACADEMY OF HEALTH SCIENCES
Authors: Kayastha Nirajana , Shrestha Sandeep , Sindan Namrata
Published: May 2022

Background: Adolescent pregnancy is a multifactorial social and global health problem, es­pecially in remote, rural setting in low-middle-income countries. This study was conducted to determine the perinatal outcome of adolescent pregnancy of this region.
Methods: A retrospective study was conducted in Karnali Academy of Health Sciences (KAHS), Jumla among nulliparous pregnant adolescent women aged 15 to 19 years (n=363) and those aged 20 to 24 years (n=445) who delivered in this hospital from April 2017 to April 2020 AD. Maternal and perinatal characteristics were compared between these groups. The categorical data between adolescent and adult women were compared. Chi-square test, Odds ratio and 95% confidence interval were examined using SPSS version 16.
Results: During the study period, the incidence of adolescent pregnancy was 22%. The adolescent mothers had significantly higher incidence of anemia (p=0.005, OR:2.7; 95% CI:1.34-5.78), abnor­mal fetal presentation (p=0.006, OR:3.1; 95%CI:1.38-7.31) and preterm deliveries (p value<0.0001, OR:3.47; 95% CI:1.94-6.19). Regarding perinatal outcome, low birth weight (LBW) babies (p=0.02, OR:1.56; 95% CI:1.07-2.29), lower mean birth weight (2715+/-586 grams) and early neonatal deaths (NNDs) (p=0.02, OR:2.52; 95% CI:1.12-5.69) were significantly associated with adolescent mothers. There was a higher proportion of neonatal admission in adolescent group compared to adult group (p=0.0006, OR:2.18; 95% CI:1.39-3.40).
Conclusions: Adolescent pregnancy is associated with increased risk of anemia, preterm delivery, low birth weight, early neonatal deaths and neonatal admissions. Targeted interventions from the community to health care level are important to decrease the adverse perinatal outcome of ado­lescent pregnancy.
KIDNEYS IN COVID-19: VICTIM WITHOUT A FAULT
Authors: Sedhain Arun
Published: May 2022

N/A
ETHICAL CHALLENGES IN HOSPITAL DUTY: NEPALESE NURSES’ LIVED EXPERIENCE
Authors: Sharma Muna , Sharma Kalpana
Published: May 2022

Background: Nursing is ethically grounded profession. Nurses work in proximity with patients where they may encounter ethical problems too. However, little is known about the ethical chal­lenge of nurses working in Nepal. Therefore, this study was undertaken to explore lived experience with ethical challenges among nurses working in government hospitals of Kathmandu, Nepal.
Methods: Qualitative phenomenological design was carried out among nurses working in the five government hospitals of Kathmandu, Nepal. Twelve nurses who had greater than 5 years of work experience in patient care were selected purposively for the study. Data was collected through face to face interview method using in-depth interview guideline. All interviews were recorded in a digital voice recorder. The collected verbatim was transcribed and analyzed thematically.
Results: All nurses experienced ethical challenges and perceived stress from those challenging situations. Three main themes derived from the participants’ experiences of ethical challenges were: errors in patient management; justice to the patient; burn out from duty. Nurses found inappropriate service to the patients, limited access of treatment and care to the patients, errors in procedure, autonomy and confidentiality issues, compromised respect and dignity of patients. When nurses found stressful working situation and conflicting legal and moral obligations, they felt burnout that leads to compromised quality of patients care.
Conclusions: Nurses experience different ethically challenging situations in their duties. Experi­ences of these challenging situations are stressful and it affects nurses’ ability to deliver quality service. Hence, attention should be given to address ethical challenges of nurses.
RETINAL ARTERIAL MACROANEURYSM: A CASE REPORT
Authors: Chaudhary Sushma , Gupta Sharad , Yadav Reena , Gupta Vidisha , Shrestha Satbodh , Bista Bipin , Choudhary Shrawan Kumar
Published: May 2022

Retinal arterial macro-aneurysms are pathological dilatations of retinal arterial branches mostly found in posterior pole. Here we present a 51 years old female with a diagnosis of retinal artery macro-aneurysm in the superior temporal arcade associated with macular edema based on clinical and optical coherence tomography (OCT) finding. Patient was treated with intra-vitreal injection (1.25 mg in 0.05 ml) of anti-vascular endothelium growth factor (bevacizumab) which showed both improvement in visual acuity and resolution of macular edema. Intra-vitreal injection of bevacizumab (Avastin) is safe and effective in treatment of macular edema associated with retinal arterial macro-aneurysms.
ERRATUM of Issue 33 JCMC 2020
Authors: Journal of Chitwan Medical College
Published: May 2022

The online and print version of the “Knowledge, attitude and practice of self-medication among medical students during exam time”(Bhattarai AK, Karki PK. Knowledge, attitude and practice of self-medication among medical students during exam time. Journal of Chitwan Medical Col­lege.2020;10(33):25-8.) has been updated according to the respective authors’ reply published in JCMC 33 Issue.

Following correction has been done:

Department of the co author Prabin Kumar Karki should be Physiology instead of Biochemistry.
DIAGNOSTIC STABILITY OF DISSOCIATIVE DISORDER DURING FIVE YEAR FOLLOW-UP IN TERTIARY HOSPITAL OF NEPAL
Authors: Sedain Chandra Prasad
Published: May 2022

Background: The stress on unconscious mind converted to physical symptoms or the disso­ciation of stress in to physical symptoms, called dissociative (conversion) disorder. The aim of the study was to identify diagnostic stability of dissociative (conversion) disorder during five years follow-up among patients with dissociative (conversion) disorder attending psychiatry department of Chitwan Medical College Teaching Hospital, Bharatpur, Nepal.
Methods: A prospective follow-up study was conducted among 253 patients with dissociative (conversion) disorder attending in the department of psychiatry of CMC-TH. Consecutive sampling technique was used to select the sample and data was collected through face to face interview method using structured interview schedule. Obtained data were analysed using ICD-10 DCR (Di­agnostic Criteria Research). The cases for study were taken during one year period. The follow up were done after 1 month, 1 year, 3 year and 5 year. The ratios and proportions were used for statistical analysis.
Results: After 5 years follow up, 72 patients did not come for regular follow-up visit i.e. Subject absent was 28.46%. out of 181 patients, highest percentage of patients were diagnosed as mania/ BPAD l (N-45, 24.86%) followed by depressive disorder (N-37,20.44 %), hypomania/BPAD II (N-24, 13.26%), and conversion disorder conversion disorder (N-8, 3.16%). More than one third (N´=64, 35.36%) of the patients were improved (N-64, 35.36%).
Conclusions: Diagnostic stability among patients with conversion disorders is very low after 5 years of follow up. They showed other disorders like mania/BPAD1, depressive disorder, hypomania/ BPAD II etc. Hence, regular follow-up and assessment using diagnostic criteria is essential for pa­tients with dissociative (conversion) disorder for their proper treatment.
PREOPERATIVE NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTOR OF THE SEVERITY OF ACUTE APPENDICITIS
Authors: Bhattarai Abhishek , Devkota Pragya , Bhattarai Suraj Raj , Karna Nitesh  Kumar , Shrestha Anup , Tamarakar Kishor Kumar , Neupane Harish Chandra , Timalsina Santosh
Published: May 2022

Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cated and uncomplicated acute appendicitis (AA) preoperatively. However there is a consid­erable difference in the cutoff values of NLR in different studies. This study aimed to establish a cutoff value of NLR to distinguish complicated AA from uncomplicated AA preoperatively at our center.
Methods: This was a prospective observational study conducted over 2 years from January 2017 to December 2019 in the department of surgery, Chitwan Medical College Bharatpur. Patients with a provisional diagnosis of AA and undergoing appendectomy were included in the study. The difference in NLR between the two groups was compared by Mann-Whitney U-test. The predictive ability of NLR was estimated by the receiver operating characteristic (ROC) curve analysis.
Results: One hundred eighty-eight patients were included in the study, 112 patients were males and 76 were females. Among them, 29.2% (n=55) were complicated AA. Median NLR was signifi­cantly higher in the complicated AA group compared to the uncomplicated group (6.90 vs 4.27, P <0.001). On ROC analysis, the predictive ability of NLR for complicated AA was acceptable (AUC: 0.705, p <0.001). The optimal cut-off value of NLR to predict complicated acute appendicitis was 4.77, with sensitivity and specificity 74.5% and 65.4% respectively.
Conclusions: NLR ≥ 4.77 can be a useful adjunct in predicting complicated AA preoperatively. But because of poor sensitivity and specificity, a lower value does not exclude complicated AA. and therefore other biochemical and radiological parameters have to be taken into consideration.
CLINICAL SPECTRUM OF PEDIATRIC DERMATOSES IN PATIENTS ATTENDING A TERTIARY CARE CENTER IN CENTRAL NEPAL
Authors: Paudel Sangeeta , Uprety Shraddha , Thapa Pratichya
Published: May 2022

Background: Skin diseases are common health problem in children all over the world. How­ever, there is scarcity of epidemiological studies on pediatric dermatoses in Nepal. This study was done to identify the pattern and age variations of pediatric dermatoses in a tertiary care centre in central Nepal.
Methods: All children 18 years and below with skin disease attending dermatology OPD between the period of June 15, 2019 to December 15, 2019 were included in the study. SPSS 20 was used for statistical analysis with which descriptive statistics was done.
Results: A total of 2789 patients (60.1% male and 39.9% female) with 2895 diagnoses were re­corded during this period. The most common dermatoses were infections and infestations (62.8%) followed by eczema (12.1%), acne (7.5%) and urticaria (4.8%). Pigmentary disorder constituted 2.6%. Insect bite reaction was seen in 2.6%, miliaria 2 %, papulosquamous disorders 1.5% followed by disorders of hairs and nails 0.9%.
Conclusions: This study revealed the most prevalent skin diseases in children in specialized der­matology clinic in a developing country such as Nepal. Fungal infection was commonest disease in adolescent and school age children whereas bacterial infection was commonest in infants, toddler and preschool children. Acne was predominantly seen in adolescent.
DEPRESSION, ANXIETY, STRESS AND BEHAVIORAL RESPONSE RELATED TO COVID-19 PANDEMIC AMONG GENERAL POPULATION
Authors: Saud Mithu , Timalsina Punjita , Tiwari Durga , Shrestha Shova
Published: May 2022

Background: Since the December 2019, a novel corona virus disease (COVID-19) first identi­fied in China, spreading around the world and infected millions of people. This pandemic has severely affected the socio-economic and mental health status of people due to lockdown and great uncertainty of elimination of the virus. This study aim to identify the depression, anxiety, stress and behavioral response related to COVID-19 pandemic among general popu­lation of Kathmandu Valley.
Methods: A descriptive cross sectional study carried out using convenient sampling duringCO­VID-19 Pandemic. Data was collected by using structured standard DASS 21 scale. The SPSS version 22 was used to analyze data.
Results: There were total 411 general people participated, among them 25.3%, 22.9%, and 11.9% had mild to extreme severe level of depression, anxiety and stress respectively were prevalent. There is a statistical significant association between marital status, educational level and level of depression at 95% confidence level (p value< 0.05). Majority of respondents had change their behavior as maintaining hand hygiene, wore a mask and had limited physical contact with people. There is a statistical significant between age, gender and level of education with recently avoiding smoking and drinking related behavior.
Conclusions: This study concludes that the general population had depression, anxiety and stress because of the fear of getting infection; people were more likely change their behavior to prevent the risk of infection. This study suggests addressing the need of mental health services such as counseling, hotline services and desk by the stakeholders to promote mental wellbeing of people.
OSSIFYING FIBROMYXOID TUMOR- A CASE REPORT
Authors: Liaquat Ahmad , Naseer Rabia , Riaz Nabeela , Haq Ehsan Ul
Published: May 2022

Ossifying fibromyxoid Tumor (OFMT) is a neoplasm of varying histopathology; it is rare and affects males of middle age. It has an intermediate malignancy potential (rarely metastasizing). The clinical picture of OFMT presents as a slowly expanding mass, which arises from subcutaneous tissue and is not fixed to underline bone. Presented here is a case of eleven years old female presented with a chief complaint of aesthetically unpleasing, slowly enlarging painless mass on the right side cheek of the face.
QUALITY OF CARE AND PATIENT SAFETY
Authors: Lamsal Daya Ram
Published: May 2022

N/A
THE INCIDENCE OF SURGICAL SITE INFECTION IN ACUTE NON PERFORATED APPENDICITIS
Authors: Bhattarai Suraj Raj , Tamrakar Kishor Kumar
Published: May 2022

Background: Appendectomy is the most commonly performed emergency surgical procedure and has significant morbidity of surgical site infection (SSIs). Regarding this, there are conflicting reports and dilemma on use of optimal duration of antibiotics. The aim of this study was to evaluate the incidence of SSIs after three doses of perioperative prophylactic antibiot­ics (single dose before surgery and two doses postoperatively) after ap­pendectomy in acute non- perforated appendicitis (NPA).

Methods: This cross-sectional study was conducted in the department of General surgery, Chitwan Medical College Teaching Hospital, from May 2018 to April 2019. All the cases received single dose of antibiotics (cef­triaxone and metronidazole) during the induction of anesthesia and two doses of the same antibiotics postoperatively within 24 hours. SSIs was assessed on 2nd and followed up till 7th postoperative day. The data col­lected was analyzed using SPSS version 16.

Results: In the study of 100 patients, who received perioperative three doses of antibiotics, the overall frequency of SSIs on 2nd and 3rd post-operative day were 2% (p=.840) and 6% (p=.539) respectively, which was statistically not significant. In follow up after 3rd postoperative day, there was no evidence of SSIs. Statistically there was no significant difference in the incidence and grade of SSIs between age group, sex and duration of operation.

Conclusions: A combined three doses of perioperative antibiotics was ad­equate for SSIs prevention in patients of any age group and sex with acute NPA after appendectomy in usual operative time.
REPRODUCTIVE HEALTH STATUS OF MARRIED WOMEN PARTICIPATING IN CERVICAL CANCER SCREENING IN KATHMANDU
Authors: Sherpa Ang Tshering , Singh Neeti , Bajracharya Manisha , Pradhan Amita , Pradhan Peru
Published: May 2022

Background: Reproductive health of women has been the central agenda of Cairo conference since its inception in 1999. As a signatory country for Cairo Conference, Nepal government is also committed for reproductive rights for Nepalese women. Despite this, reproductive health challenges do exist in Nepal. This prompted us to determine the reproductive health status of married women attending in cervical cancer screening in Kath­mandu.

Methods: Cross sectional study was designed to include retrospective data of married women, obtained during cervical cancer screening camp conducted by KIST Medical College at Laga Khala Clinic, Lagan, Kathmandu on 12-02- 2017. Among married women (131) attended cervical 100 wom­en’s records with complete set of data for reproductive health variables required for the study were included in this study. Statistical analysis was done descriptively.

Results: Participant’s age is between 21 years to 61years, 83% are liter­ate and 46% are employed. Adolescence marriage and pregnancy were two main problems noted. Cervical examination in relation showed 3% (3) VIA positive, 33% (33) Cervicitis, 10% (10) cervical polyp, 7% (7) atrophic vaginitis, 4% (4) cervical erosion and 43% (43) healthy cervix. Regarding Knowledge about risk factor majority 92% (92) had either no knowledge or only some extent of knowledge.

Conclusions: Married women who lives in Kathmandu has significant re­productive health problem. Urban health program should address these issues.
AWARENESS, KNOWLEDGE AND WILLINGNESS REGARDING EYE DONATION AMONG DENTAL STUDENTS OF KIST MEDICAL COLLEGE AND TEACHING HOSPITAL,LALITPUR,NEPAL
Authors: Basnet Anjila , Basnet Pragya Singh , Lamichhane Ram Sudhan , Shrestha Prabhat
Published: May 2022

Background: Corneal disease constitutes a significant cause for visual im­pairment and blindness in the developing world. Visual rehabilitation by corneal transplantation for which increased awareness regarding an eye donation is essential, remains the only treatment option for restoring sight in those who suffer from corneal blindness. Hence, the present study con­ducted to assess the awareness, knowledge and willingness about eye do­nation among dental students of KIST medical college & teaching hospital, Nepal

Methods: A cross-sectional study was carried out in KIST medical college and teaching hospital in Nepal during the period of 21st to 30th April 2019. A total of 185 dental students were selected as study group by con­venience sampling technique. A Semi-structured questionnaire was used for data collection and analyzed by using SPSS 16. Descriptive statistics and Chi square/ Fischer exact tests were used for data analysis.

Results: Out of total 185 dental students who participated in this study, 176 (95.1%) were aware about eye donation, 133 (71.9%) knew that the cornea is used for eye donation and 70 (37.8%) knew that ideal time for eye donation is within six hours of death. Awareness regarding eye dona­tion in male and female students was found to be statistically significant (p =0.013).

Conclusions: The present study revealed that most of the dental students were aware regarding eye donation and most of them were willing to do­nate their eyes. Awareness regarding eye donation will form the prime base for the elimination of avoidable corneal blindness in Nepal.
QUALITY OF LIFE AMONG OSTOMATES ATTENDING AT A CANCER HOSPITAL, CHITWAN, NEPAL
Authors: Neupane Laxmi , Thulung Bedantakala
Published: May 2022

Background: Stoma is a global public health problem. Stoma can be tem­porary or permanent and creates multiple difficulties in terms of quality of life (QoL). So the QoL of ostomates needs to be regularly assessed. The objective of the study was to find out the Quality of life among ostomates attending outpatient clinics at a Cancer Hospital, Chitwan.

Methods: A descriptive cross sectional study was conducted among 138 ostomates. Consecutive sampling technique was used by face to face in­terview method using standard tool “City of Hope Quality of Life Question­naire for a patients with an ostomy”. Data were analyzed by using descrip­tive and inferential statistics.

Results: The mean QoL of the respondents was 5.03±0.75. More than half (52.9%) of the respondents had lower QoL. Statistical significant associa­tion was found between QoL of the respondents and recent involvement in occupation (p<0.001), duration of having stoma (p=0.049) and stoma related complications (p=0.014). There is a positive correlation between overall QoL of the respondents and QoL in physical domain (r=0.632, p<0.001), psychological domain (r=0.723, p<0.001), social domain (ρ =0.809, p<0.001) and spiritual domain (r=0.581, p=0.001) respectively.

Conclusions: It is concluded that more than half of respondents had low­er QoL. Here, stoma affects all domains of QoL of ostomates. Qualitative study explores all aspect of life more effectively. Counseling must be di­rected to continue job, adjustment to changed life style and prevention of complication.
ADEQUACY OF THREE DIMENSIONAL MINIPLATE IN TREATMENT OF MANDIBULAR FRACTURE IN INTERFORAMINAL REGION
Authors: Singh Vivek , Giri Ritesh
Published: May 2022

Background: Mandible is one of the commonly fractured bone due to trauma, assault and falls. Treatment includes closed and open methods. Methods of open reduction and internal fixation have changed and di­versified enormously in the past few years. Champy’s miniplate fixation, dynamic compression plating has become a standard approach. More recently, three dimensional miniplates have been developed by Farmand which may be effectively used in mandibular fractures. The aim of this study was to check the adequacy of three dimensional miniplate in man­agement of mandibular fracture occurring in the interforaminal region.

Methods: A prospective clinical study was carried out in patients attend­ing Emergency Department and Department of Oral and Maxillofacial Surgery, Nobel Medical College and Teaching Hospital (NMCTH) suffer­ing from mandibular fractures in interforaminal region from May 2018 to January 2019.

Results: A total of 17 patients with 18 fracture in interforaminal region, all male were included in the study. The age ranged from 16 to 50 years with a mean of 29.17 ± 9.48. Road traffic accident was the leading cause of injury with 15 out of 17 patients (88.23%). There was no incidence of wound infection, wound dehiscence, malunion, nonunion, plate fracture within the follow up period of 3 months. One fracture was unstable on 1st postoperative day and also had mildly deranged occlusion which was man­aged with intermaxillary fixation for two weeks.

Conclusions: Three dimensional plates fulfills the treatment goals of ad­equate stabilization and fixation of mandibular interforaminal fractures.
EXPLORING THE SUBSTANTIAL ROLE OF MULTIPLEX PCR TO DIAGNOSE MALARIA IN EASTERN NEPAL
Authors: Bhattarai Narayan Raj , Rai Keshav , Rijal Suman , Ghimire Anup , Khanal Basudha
Published: May 2022

Background: Malaria is still a major health problem in Nepal as 43.3% of population are at risk of infection. However, the national priorities have been given to achieve malaria elimination in Nepal, the question of diag­nostic accuracy could jeopardize the elimination target. Among others, multiplex PCR could be the reliable alternative tool to detect the low num­ber of parasitemia and circulating asymptomatic infection in low endemic countries like Nepal. Hence, this paper aims to analyse the diagnostic pre­cision among microscopy, rapid diagnostic test (RDT) and multiplex real time PCR assay.

Methods: A total of 63 archived blood samples obtained from patient with clinical suspicion of malaria were subjected to multiplex PCR and their re­sults were compared with microscopy and rapid diagnostic test. The La­tent Class Analysis (LCA) approach was used to compare the diagnostic precision among three different assays.

Results: Our study documented that PCR had 97.4% sensitivity and 83.9% specificity. Among the negative microscopy results, 10 (15.9%) were false negatives whereas 4 (6.3%) RDT results were false negatives based on PCR results.

Conclusions: PCR could be the useful alternative tool to detect the low number of parasite in low endemic settings which could be crucial to rule out the false diagnosis determined by microscopy or RDT.
THORACOPHAGUS CONJOINT TWIN: A CASE REPORT
Authors: Paudel Dipesh , Dhakal Radha Devi , Adhikari Deepak
Published: May 2022

A 27 years old primigravida woman at 19 weeks of gestation was came for routine antenatal checkup in Chitwan Medical College was diag­nosed as twin pregnancy with thoracophagus conjoined twin. The fetal biometrics of both were consistent with the gestational age. Fetuses were found with fusion of the skin contour, at the level of the lower chest with complex appearing fused cardiac near midline and liver ap­pears separate. Both fetal heads were in breech presentation facing faces with each other at the same level. Bilateral upper and lower limbs were identified in both fetuses with same gender. The parents decided to terminate the pregnancy but refused autopsy.
IMPLANT DENTISTRY – CURRENT TRENDS IN REHABILITATION OF MISSING TEETH
Authors: Thakur Smriti Narayan
Published: May 2022

N/A
COMPARATIVE STUDIES OF BONE DENSITY BY QUANTITATIVE ULTRASOUND (QUS) WITH DUAL-ENERGY X-RAY ABSORPTIOMETRY (DEXA) SCAN
Authors: Rajouria Alark Devkota , Bhattarai Madhur Dev , Bajracharya Manil Ratna , Karki Buddha Bahadur
Published: May 2022

Background: The aim of the study was to establish the correlation quantitative ultrasound (QUS) between and dual-energy X-ray absorp¬tiometry (DEXA) and to assess the ability of QUS as a screening tool for osteoporosis.Methods: The study was conducted on 115 patients. All the patients underwent QUS of radius using Sunlight MiniOmni bone sonometer and DEXA screening for measurement of bone mineral density (BMD) at lumbar spine, total left & femoral neck and radius.Results: Significant correlations were observed between QUS and DEXA T score.Conclusions: QUS is a sensitive screening tool to detect changes in the bone mass and risk of osteoporosis.
NURSES’ KNOWLEDGE AND PRACTICE REGARDING INTRAVENOUS THERAPY IN A TEACHING HOSPITAL, BHARATPUR
Authors: Lamsal Sandhya , Shrestha Rosy
Published: May 2022

Background: Intravenous (IV) therapy is a common procedure in clinical setting of any hospital and nurses are accountable for handling and man­agement to the patient with IV therapy. However, various serious medical complications were arisen due to nurses having inadequate knowledge and practice on IV therapy. Therefore, this study was conducted to find out the nurses’ knowledge and practice regarding IV therapy in a teaching hospital, Bharatpur, Chitwan.

Methods: A cross- sectional study design was adopted with 177 nurses for assessment to knowledge and 53 nurses to observe practice on IV therapy. A systematic random sampling technique was used. Data were collected by using semi-structured, self-administered questionnaire for identifying knowledge and observation checklist for observing the practice of IV ther­apy among nurses. The data was analyzed using descriptive and inferential statistic.

Results: The level of knowledge was found inadequate and level of prac­tice was found unsatisfactory on IV therapy. The associated factors with level of knowledge regarding IV therapy were age (p=0.012), professional qualification (p=0.001), professional designation (p=0.005), professional experience (p=0.002) and in-service education (p=0.003). Similarly, the associated factors with level of practice on IV therapy were professional qualification (p=0.020) and professional designation (p=0.04).

Conclusions: It is concluded that most of the nurses had inadequate knowledge and unsatisfactory practice on IV therapy. Hence, it is strongly recommended for need of protocol for IV therapy, in-service education, effective supervision and reinforcement for improvement of knowledge and practice regarding IV therapy among nurses.
PULMONARY FUNCTION TESTS OF MONGOLOID AND NON MONGOLOID GROUP OF DHARAN
Authors: Ghimire Nisha , Agrawal Kopila , Deo Santosh , Chaudhary Lok Bandhu , Paudel Bishnu Hari
Published: May 2022

Background: Ethnicity is seen to effect normal reference values and pre­diction equations of pulmonary function tests (PFTs). The normal refer­ence of PFTs among mongoloid and non mongoloid group of Dharan is not available. The aim of the study was to find out the normal reference val­ues of two groups in Dharan and also to find out the correlation of height, weight and body surface area with different PFT parameters.

Methods: This cross-sectional study was conducted among 250 (125 mongoloids and 125 non mongoloids) healthy male subjects. Convenient sampling technique was done. Every 5th patient attendant who was per­manent resident of Dharan coming to clinical Physiology lab was selected as subject in each group. Portable PFT machine (CHESTOGRAPH, HI-101 Spirometry system) was used for measurement of our test. The test was conducted according to European Respiratory Society (ERS)/American Thoracic Society (ATS criteria.

Results: Independent sample t-test was used to compare means be­tween two groups. There was significantly more height (165.30±8.21 vs 161.43±7.35), p <.05], weight [(59.29±11.64 vs 55.32±10.75), p<.05andbody surface area [(1.64±.172Vs1.57±.149), p<.05], in the non-mongoloid group compared to mongoloid group. PFT param­eters were also higher in non-mongoloid group VC [(3.3982±.70725 Vs3.0982±.78832) p<.05], FVC [(3.2798±.74312 Vs 2.988±.81970), p <.05], and FEV1 [(3.0668±.72044 Vs 2.7861±.83061) p<.05]. The prediction equations were also calculated for both groups.

Conclusions: There was difference in PFT parameters between two groups. Prediction equations were also different in both groups.
INTRANASAL FINDINGS IN UNILATERAL PRIMARY ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION
Authors: Thakur Sanjeev Kumar , Yadav Baleshwar , Bedajit Raj Kumar , Agrahari Akash , Singh Sanjay Kumar , Afaque Anwar
Published: May 2022

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common entity with associated different types of intranasal abnormali­ties. The pathogenesis of PANDO is unknown. The objective of the study was to describe the intranasal findings in cases of PANDO and find out any association of these findings to the disease.

Methods: A comparative cross-sectional study was designed consisting of 50 cases of unilateral PANDO with epiphora and 50 normal volunteers with no history of epiphora. Nasal Evaluation was done with anterior rhi­noscopy and nasal endoscopy. Data was tabulated and analyzed using SPSS version 21.

Results: The mean age in the unilateral PANDO group was 33.6 years and 34.5 years in the normal volunteer’s group (P-0.84). Left sided dominance of PANDO was observed in 64% (32/50) cases. The odds of having Na­solacrimal duct (NLD) obstruction was1.6 times more among individuals having septal deviation versus no deviation (95% CI, 0.907–2.78). The lat­erality of septal deviation was corresponding to the side of NLD obstruc­tion in 91% (31/34) cases. High located DNS was more common in the PANDO group which was significant (P-value 0.012). Turbinate hypertro­phy, the presence of septal spur or rhinitis had no significant association with NLD obstruction.

Conclusions: Deviated nasal septum (DNS), turbinate hypertrophy, septal spur and rhinitis were the associated intranasal findings in cases of uni­lateral PANDO. A significant association exists between DNS and PANDO, although a cause and effect relation require further probing.
ENDOUROLOGICAL MANAGEMENT OF FORGOTTEN DOUBLE J STENTS: CASE SERIES
Authors: Yadav Chandra S , Kunwar Ashok Kumar , Shrestha Sanjesh , Tiwari Kabir , Upadhyay Amit Mani , Dangal Ganesh
Published: May 2022

Putting ureteral stents are an integral part of urological practice. However, stents that fragment or are forgotten for a long time pose a management challenge and also legal dilemma. Our series consists of a review of five patients with forgotten double J stents. All these cases were managed at Kathmandu Model Hospital and all the forgotten stents were retrieved en­dourologically. Management of such complicated ureteral stents requires a multimodal therapeutic approach incorporating the latest ESWL and endou­rological techniques. Proper counseling to the patient with reference from post-operative KUB X-ray may prevent this urological tragedy.
AMNION GRAFT VAGINOPLASTY IN VAGINAL AGENESIS
Authors: Poudel Sandesh , Dangal Ganesh
Published: May 2022

Vaginal agenesis seen in Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a condition with significant psychological and social consequences where there is embryonic underdevelopment of müllerian duct. It is estimated to occur one in 4000 to 5000 live births. Normalizing sexual life with vaginal reconstruction to adequate length is usually the treatment of choice. Among many non-surgical and surgical options available, McIndoe vaginoplasty is the commonest surgical management performed worldwide with various modifications, like the use of amnion as a graft. A 19-year-old girl with normal secondary sexual characters came with vaginal agenesis with hypoplastic uterus. MRI revealed streak like structure over the pelvis with imperforate hymen and atresia of the vagina. Surgical intervention included creation of vaginal canal from a potential space between urethra and bladder above and rectum below and a fresh amnion mounted mould was placed within the canal. The amnion graft was seen well taken with resultant 4 to 5 cm of vaginal canal when mould was removed 10 days later. She was counselled and taught to remove and insert the mould to prevent vaginal narrowing and maintain the length. Amnion graft vaginoplasty has with good success rate with minimal postoperative pain, infection and scarring and thus is a rewarding procedure especially in low resource countries.
SPECTRUM OF OCULAR DISEASES IN AFTERMATH OF MONSOON FLOOD IN NEPAL
Authors: Sahu Sabin , Wangchuk Bhutia Tshering , Shrestha Varun , Malla Tejsu , Kumar Singh Sanjay
Published: May 2022

Background: Floods are common global natural disasters that occur occasionally in Nepal. Numerous environmental damages and health impacts are known to occur due to direct effect of flooding. There are limited studies reporting the ocular diseases after the event of floods using a large population data. We aimed to present the spectrum of flood-related ocular diseases after monsoon flood in Nepal using a community-based database.

Methods: A descriptive, cross sectional study design was used to collect the data from di­agnostic screening and treatment camps organized in flood-affected areas between one to three weeks after the monsoon flood in Nepal. The data was analyzed using the excel sheet and the results were presented in frequency and percentage in the frequency distribution tables.

Results: The children and elderly constituted majority of patients. Females constituted 54% while males were 46% of the total patients presenting at the camps. The incidence of infec­tive ocular diseases was 23.8% and that of traumatic ocular injuries was 6.2% of total ocular diseases. Acute conjunctivitis was the most common infective ocular disease (21.1%) fol­lowed by keratitis (2.7%). Corneal abrasions (1.4%), subconjunctival hemorrhage (1.1%) and lid ecchymosis (0.7%) were common clinical diagnosis following traumatic ocular injury.

Conclusions: The infective ocular diseases and traumatic ocular injuries are common flood-related ocular diseases seen within one to three weeks after flood receded. The knowledge of these expected ocular morbidities may help for proper planning and organization of such relief camps. Early diagnosis and treatment of these diseases can reduce the ocular morbidi­ties.
MIRROR OF UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN LUMBINI PROVINCIAL HOSPITAL
Authors: Joshi Pushpa Raj , Pokhrel Sharad , Thapaliya Narad Prashad
Published: May 2022

Background: Upper Gastro Intestinal (UGI) endoscopy is a common and important procedure for UGI problems. In Nepal, especially to this region, there have not been many scientific studies about the pattern of diseases seen on UGI endoscopy. This study aimed to enlist patterns of upper GI endoscopic findings done in Lumbini Provincial Hospital.

Methods: This was a retrospective study of 200 consecutive patients who underwent UGI endos­copy from August 2017 to February 2018. Data were retrieved retrospectively from prospectively maintained data in computer-based systems and analyzed with SPSS-20.

Results: A total of 200 patients underwent UGI Endoscopy during the study period. Among them, females were 110 (55.0%) and males were 90(45.0%). The mean age of the study population was 46.3% (SD, 17.75). The pain abdomen was the most common indication for UGI endoscopy with 166 cases (83.0%) followed by gastrointestinal bleeding with 22 cases (11.0%). Benign lesions were seen in most of the cases which include non-ulcerative lesions 117(58.5%) and ulcerative benign lesions 72(36%). Malignancies found in 7(3.5%) cases and normal findings in 4 cases.

Conclusions: This study outlines the most common indications for upper GI endoscopy in our set up and disease patterns in those patients. This study will be helpful for an epidemiological
ULTRASOUND GUIDED PERIPHERAL NERVE BLOCK AS ALTERNATIVE TO SUBARACHNOID BLOCK IN TOTAL HIP REPLACEMENT ARTHROPLASTY: A RETROSPECTIVE STUDY
Authors: Rayamajhi Anuj Jung , Paudel Prashanta , Paudel Subhash Chandra , Dhungel Bidur Kumar , Yadav Rupesh Kumar
Published: May 2022

Background: Ultrasound guided peripheral nerve blocks have become increasingly popular in the lower limb orthopaedic and gaining more acceptances in total hip replacement surger­ies too. The main objective of this study was to compare peripheral nerve block and spinal anesthesia for total hip replacement surgeries.

Methods: In this retrospective study, total patients that underwent total hip replacement in our institution during specific time period were included for the study. They were divided into spinal and peripheral nerve block groups, and data were collected for the analysis. USG guided lumbar plexus, sacral plexus, superior gluteal nerve block was done and conventional landmark technique was done for spinal group. Mean arterial blood pressure, total fluid con­sumption, total fentanyl consumption, pain scores and incidence of nausea was compared.

Results: We included 43 patients for the study in which 23 patients were included in nerve block group, and 20 patients in the spinal group. In compared to spinal group, nerve block group had more stable mean arterial blood pressure (P <0.05), less total fluid consumption (P=.000), lower pain scores and fentanyl consumption (P <0.05), and less incidence of nausea (4% to 20%).

Conclusions: Peripheral nerve block can be good alternative to spinal anesthesia for total hip replacement surgeries, with more hemodynamic stability and better pain management along with less opioid and fluid consumption.