bluuebunny/crossref_metadata_2025 huggingface dataset:
KABAT INTERVENTIONS INTEGRATED WITH FACIAL EXPRESSIVE AND FUNCTIONAL EXERCISES FOR BETTER AND SPEEDY RECOVERY IN BELL’S PALSY; A PRE-POST DESIGN
Authors: Adhikari Shambhu Prasad , Chaudhary Manisha , Dev Rubee
Published: May 2022

Background: Bell’s palsy (BP) is an acute and idiopathic paralysis of the seventh cranial nerve, which has higher incidence rate in Asian countries compared to the western world. Different contemporary physiotherapy interventions have been used in treatment of impairments and functional limitations caused due to the BP. However, traditional usual care is still in practice in context like Nepal, which has to be shifted to evidence-based treatment. Therefore, pres­ent study investigated effectiveness of Kabat intervention integrated with facial expressive and functional exercises in Bell’s palsy.
Methods: This pre-post comparative study recruited eight participants of age 22 to 52 years with acute and sub-acute, unilateral, idiopathic BP by purposive sampling. A physiotherapist admin­istered the Kabat intervention integrated with facial expressive and functional exercises for four weeks. Another physiotherapists assessed before as well as after two and four weeks of the treat­ment using Sunny Brook Facial Grading, House-Brackmann grading, lip-length measurement, facial disability and patients’ satisfaction measures. One-way ANOVA with repeated measures was used to analyze data across three points of time.
Results: Eight participants with mean age 41.38 years (10.66) completed the study. Significant improvement with high effect sizes (0.82 – 0.95) was found on both outcome measures across the time. There was significant improvement on lip measurement as well. The participants’ satisfaction level was 8.5 (±1.20)/10 with the intervention.
Conclusions: The Kabat intervention integrated with facial expressive and functional exercises demonstrated significant improvement in impairments and functional level. Large effect sizes and high level of participants’ satisfaction indicated clinical relevance of the intervention.
ASSOCIATION OF HYPERTENSION AND ISCHAEMIC ECG CHANGES IN TYPE II DIABETES MELLITUS
Authors: Rai Chandra Kala , Poudel Nimesh
Published: May 2022

Background: Type 2 diabetes mellitus (T2DM) is one of the most common metabolic disorders to the current generation. It usually leads to multi-systemic complications such as cardiovascular diseases, proteinuria, micro albuminuria, retinopathy, hypertension, ischaemic changes and chronic kidney disease. These complications increase the morbidity and mortality of patients.  The prolonged hyperglycemia leads to vascular damage. It causes insufficient blood flow to the cardiac muscles which may cause myocardial or cardiac ischaemia. The aim of this study was to find out the prevalence of hypertension and ischaemic ECG changes in T2DM patients attending Kathmandu Medical College.

Methods: Total 360 type 2 diabetic patients were included. Blood pressure was measured and electrocardiogram (ECG) was recorded by 12 leads ECG. Statistical analysis was done using SPSS version 16. P<0.05 was considered to be statistically significant.

Results: The mean age of the patients was 66.88 ± 1.52 years, age ranging from 40 – 95 years. In this study 168 patients (46.66%) had systolic hypertension, 204 patients (56.67%) had diastolic hypertension and 126 (35%) had both systolic and diastolic hypertension. About 103 (28.61%) showed ECG changes in hypertensive patients. Only 4 (1.11%) non- hypertensive had ECG changes. This study showed statistically significant relation of hypertension and ischemic ECG changes in type 2 diabetes mellitus cases with p- value 0.03.

 Conclusions: There is a high prevalence of hypertension among T2DM patients. In these patients, there is a statistically significant association between hypertension and ischaemic ECG changes.
ASSESSMENT OF AWARENESS OF ORAL CANCER AMONG NURSING STUDENTS AT BPKIHS, NEPAL
Authors: Keshwar Shashi , Sarraf Deependra Prasad , Shrestha Ashish , Karn Basant Kumar
Published: May 2022

Background: Early recognition of oral cancer is essential for higher cure rate and better prog­nosis. Nurses can play a significant role in the early diagnosis of cancers. The study aimed to assess the awareness of oral cancer among nursing students.
Methods: A cross-sectional survey was conducted among Bachelor of Nursing Students at College of Nursing, B.P. Koirala Institute of Health Sciences. A semi-structured questionnaire was used to collect the sociodemographic data and awareness of cancer. Descriptive statistics were calculated using Statistical Package for Social Sciences version 22.0.
Results: Out of 116, 89 (76.7%) students were of age 21-25 years. One hundred and twelve stu­dents (96.6%) were aware that various form of tobacco increases risk of oral cancer; however, only 55 (47.4%) students knew alcohol drinking as a risk factor. Only 29 (25.0%) students were aware of loose-fitting denture as a risk factor for oral cancer. Ninety-six (82.8%) students knew white or red patch as possible signs of oral cancer; however, only six (5.2%) students were aware of the most common site of oral cancer. Only 16 (13.8%) students considered that they are adequately trained to screen oral cancer. One hundred and fifteen (99.1%) students demanded more education on oral cancer.
Conclusions: This study revealed that nursing students’ awareness of risk factors and the impor­tance of screening of oral cancer is suboptimal. It highlights a need for basic education on oral can­cer to make them more aware and further competent toward oral cancer screening and referral.
SEX PREFERENCE AND ITS ASSOCIATION WITH REPRODUCTIVE BEHAVIOR AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN A TEACHING HOSPITAL, POKHARA
Authors: Gurung Nirsuba , Singh Sakun
Published: May 2022

Background: Nepal is basically having patriarchal societies where men are considered as a head of family and society. Gender discrimination is one of the major problems in the Nep­alese society which adversely affects women health and development. So, the study aimed to find out sex preference among the pregnant women and how it affects reproductive behavior like use of family planning, abortion and fertility intension.
Methods: A cross-sectional descriptive study was carried out in Gynecology and Obstetrics outpa­tient department (OPD) of a Teaching Hospital in Pokhara. A total of 272 pregnant women were recruited through convenient sampling technique. Data collection was done by face to face inter­view. Data was entered in MS-Excel 2007 and analyzed in SPSS version-16. Chi-Square was used to find out the association between variables.
Results: The mean age of the pregnant women were 25.51 years. Almost all the respondents were literate and 69(62.1%) of them were unemployed. More than half (57%) of the respondents had never used any method of family planning. Among 272 respondents 59(21.7%) of them had son preference which was significantly associated with age (p-value-0.028), educational level (p-val­ue-0.000), and history of abortion (p-value-0.029).
Conclusions: Despite of increasing education level of women still one third of the women had sex preferences. Sex preferences leads to decrease use of family planning, increased abortion rate and high parity which affects health of the women. It was observed that reproductive behavior is relatively affected by sex preferences.
AWARENESS REGARDING INFERTILITY AMONG WOMEN ATTENDING CHITWAN FERTILITY CENTER
Authors: Dhakal Radha Devi , Lamsal Yasoda , Paudel Dipesh
Published: May 2022

Background: Infertility is a condition where couple failure to conceive after 1 year of regu­lar unprotected coitus. At least 50 million couples worldwide experience infertility. Several adverse consequences of infertility like tension, hostility, anxiety, depression, self-blame and suicidal ideation are now being increasingly recognized. This study was designed to assess the awareness regarding infertility among women attending Chitwan Fertility Center.
Methods: A cross sectional analytical study design was used and population for study includes those married women who had failure to conceive and visited to Chitwan infertility centre. The data was collected through semi-structured interview schedule. Collected data was coded and entered and analyzed in Microsoft office Excels and SPSS 20 version by using descriptive and in­ferential statistics.
Results: In present study, among 96 respondents, majority of the respondents 45.8% were from age group of 25-30 years. Most of the respondents 56.3% had completed bachelor level and above level education. Majority of women 87.5% had good awareness on infertility. There was no signifi­cant association between level of awareness and socio-demographic variables.
Conclusions: It can be concluded that the awareness about infertility among the participants at­tending Chitwan fertility center is relatively good. Most of the participants were educated, dura­tion of marriage was also 5-10years and most of them came to the infertility center for the treat­ment and management of infertility that might be the reason they have good awareness regarding infertility. But there is still misconception in some of the participants.
ANESTHETIC MANAGEMENT OF AN ELDERLY PATIENT WITH DILATED CARDIOMYOPATHY AND HYPOTHYROIDISM FOR INTER-TROCHANTERIC FRACTURE
Authors: Subedi Deepika , Aryal Diptesh , Shrestha Anil
Published: May 2022

Dilated cardiomyopathy is a primary myocardial disease characterized by left ventricular or biventricular dilation and impaired contractility. The anesthetic management of a patient with dilated cardiomyopathy   undergoing   a non-cardiac surgery is always challenging and may be associated with high mortality. Furthermore, perioperative morbidity becomes more frequent in the elderly with steep increases after the age of 75. We are reporting the successful anaesthetic management of a 93 years old patient with severe dilated cardiomyopathy planned for surgical repair of inter-trochanteric fracture under combined spinal anesthesia.
STRESS AND ANXIETY AMONG NURSES WORKING IN TERTIARY CARE HOSPITALS IN NEPAL DURING COVID- 19 PANDEMIC
Authors: Neupane Mamata Sharma , Angadi Siddeshwar , Joshi Alisha , Neupane Harish Chandra
Published: May 2022

Background: Healthcare workers like nurses’ are the primary group who come in contact with patients, an important source of exposure to infected cases in healthcare settings. Co­rona Virus Disease 2019 (COVID-19) pandemic has brought all the health care professionals including nurses to work as a frontline member which may bring threat to mental wellbeing. The nurse’s psychological impact including stress and anxiety remains unknown. Hence, this study aimed to assess the stress and anxiety regarding COVID-19 among nurses working at Chitwan medical college and teaching hospital.
Methods: A Descriptive cross-sectional survey was carried out among nurses working in Chitwan Medical College and teaching hospital. A total of 181 Nurses were selected through non probability consecutive sampling from various wards of Chitwan Medical College and Teaching Hospital. Data was collected using structured questionnaire. Data analysis was performed in SPSS version 20 for window using descriptive statistics.
Results: The findings of the study revealed that out of 181 nurses 54.7% nurses reported moder­ate and 37.6% reported high level of stress and 10.5% of nurses reported mild to moderate level of anxiety.
Conclusions: Considerable proportion of nurses working in different wards of hospital appear to experience some degrees of stress and anxiety during COVID-19 pandemic. Hence, it is essential that health organization takes measures to improve nurses’ mental health by intervening stress management programme to ensure positive attitude and maintain mental well-being.
NEEDLE ASPIRATION IN PERITONSILLAR ABSCESS: OUR EXPERIENCE IN CHITWAN
Authors: Limbu Tilak Raj , Baral Sovit Jung , Jha Amit , Lamichane Donjon
Published: May 2022

Background: Peritonsillar abscess is one of deep neck space having significant morbidity and mor­tality. The treatment is still controversial regarding best method to perform. The aim of the study was to study the effect of needle aspiration in the treatment of peritonsillar abscess among the patients of Chitwan Medical College.
Methods: A retrospective study was designed which included all aged patients and were admitted in tertiary centre for peritonsillar abscess treatment between January 2015 to December 2019. All patient was treated with needle aspiration method under local spray anaesthesia and intravenous antibiotics. Number of aspirations, hospital stay, recurrence and complications were assessed as main outcomes. Descriptive analysis was performed by using SPSS version 16.0.
Results: Over 5-year duration, 57 patients were admitted for PTA and included for analysis. About 45(78.9%) of patients were under 40 years. Male dominance of 41(71.6 %) was found. All cases were unilateral and no significant laterality found. All patients had prior medications outside be­fore hospital visit. Length of hospital stay was 3.11+/-.939 days. Single or repeat aspiration of pus showed significant improvement of symptoms. One patient had recurrence and another one case had developed complication.
Conclusions: Our study showed needle aspiration is effective modality for peritonsillar abscess treatment due to early clinical improvement, low recurrence and decrease hospital stay.
PSYCHOSOCIAL PROBLEMS AMONG SCHOOL GOING ADOLESCENTS IN GHORAHI SUB METROPOLITAN CITY OF DANG
Authors: Devkota Sapana , Adhikari Kishor , Ghimire Amrita , Koirala Subash , Chhetri Mamta
Published: May 2022

Background: A psychosocial problem is a mental illness caused or influenced by life experiences, as well as maladjusted cognitive and behavioral processes. Psychosocial problems i.e. internalizing dis­orders, externalizing disorders and substance abuse are more prevalent among adolescents because of their rapid physical and physiological changes that occur in their body during this stage. The aim of the study was to identify the magnitude of psychosocial problems among school-going adolescents.

Methods: Present study was a descriptive cross-sectional study conducted in the ward no. 15 of Gho­rahi sub metropolitan city of Dang District, Nepal. A total of 325 adolescents were chosen from multi-staged random sampling. Pre-tested self-administered questionnaire was used to collect data. Part I and part II of questionnaire was self-constructed and Part III was adopted from standard tool of Youth Pediatric Symptoms Checklist. Descriptive (percentage, frequency, interquartile range and minimum and maximum values) and inferential analysis (chi-square test) was done through this IBM SPSS soft­ware version 20.

Results: The prevalence of psychosocial problems among school going adolescents was 26.8%. Socio-demographic characteristics such as age, ethnicity, occupational status of respondent’s father and mother were found to be significantly associated with psychosocial problems. The relation with teach­er and academic grade of respondent were found to be highly associated with psychosocial problems.

Conclusions: The study reported an alarming situation of psychosocial problems among adolescent students in Nepal where more than one quarter of participants found having psychosocial problems. The study may suggest the need of proper parenting and maintenance of an appropriate level of teacher-student relationship.
ASSESSING THE KNOWLEDGE, ATTITUDE AND PRACTICE OF FAMILY PLANNING AMONG MALE POPULATION IN INARUWA MUNICIPALITY OF EASTERN NEPAL
Authors: Uprety Samyog , Sharma Khem Raj , Paudel Masum , Baral Dharanidhar , Ghimire Anup
Published: May 2022

Background: Family planning allows individuals and couples to anticipate and attain their desired number of children, spacing and timing of their births. It is achieved through use of contraceptive methods. A man’s perspective on the family planning methods and services is essential on his family health. The study aimed to know about knowledge, attitude and practice of family planning methods in male (Rickshaw puller) of Eastern Nepal and to know their reasons for not using the family planning.
Methods: A descriptive cross-sectional study was done in Inaruwa municipality. Total of 400 male rickshaw puller samples were taken. Knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire. Descriptive analysis was done by using SPSS 11.5software to obtain frequencies and percentages.
Results: Out of 400 interviewed, 366 were interviewed with 92% response rate, the mean age was 36.54 years, and 92.7% said they heard about Family planning method. Health worker was the main Source of family planning information. Regarding the attitude of the Male respondents, 83.1% supported the concept of family planning; only 33.9% said they had used a male contra­ceptive, 46.7% of the respondents said the males didn’t practice the family planning methods on themselves because of the work load.
Conclusions: Majority of the respondents knew about family planning methods but only a few agreed to have used them. The main reason for men lagging behind could be that the burden of work due to which contraception in a family is taken up by females.
SURGICAL SITE INFECTION FOLLOWING CESAREAN SECTION AND ITS ASSOCIATED RISK FACTORS AT A TERTIARY CARE HOSPITAL IN CHITWAN
Authors: Mishra Renuka Tamrakar , Adhikari Kishor , Lamichhane Sandesh , Baniya Abinash , Subedi Subash , Shahi Manoj , Shrestha Swikriti , Gurung Bipana
Published: May 2022

Background: Surgical site infection following Cesarean Section is one of the major potential surgical complications with its incidence ranging from 3-15%. Morbidity and mortality are considerably in­creased after a surgical site infection placing a significant physical, emotional and economic burden on the patient herself. This study is aimed to identify the associated risk factors for postcesarean surgical site infection at a tertiary care hospital in Chitwan.
Methods: A descriptive cross-sectional study of 186 women who underwent a cesarean section was carried out in Chitwan Medical College Teaching Hospital, Chitwan, Nepal from 27thDecember 2019 to 19th February 2020. Data were collected from patients using a self-constructed questionnaire and their risk factors were studied.
Results: A total of 186 cases were studied and the incidence rate of surgical site infection was 13 (6.99%). The mean age was 26.13±4.94. Among the total cases, 87.10% of cases were literate while 12.90% of cases were illiterate. Out of total surgical site infection cases, infection was more prevalent (84.62%) among those with preoperative hospitalization of ≤ 24 hours and (53.85%) among those who stayed in the hospital for < 5 days.
Conclusions: Education level, duration of preoperative hospitalization and total hospital stay were found to be significant risk factors associated with surgical site infection and appropriate measures to address these risk factors help to lower the rate of surgical site infection.
RELAPAROTOMY IN RESIDUAL OVARIAN SYNDROME: AN APPRAISAL
Authors: Shrestha Prezma , Joshi Rawal Suniti , Sharma Nisha
Published: May 2022

Background: Hysterectomy is one of the most commonly performed surgical procedures among females, usually accompanied by unilateral or bilateral salpingo-oophorectomy. Women tend to preserve normal ovary as its removal is associated with higher risks of car­diovascular diseases, osteoporosis, neuro-psychiatric disorders, colorectal and lung cancer. However, preservation of ovary during hysterectomy may increase risk of relaparotomy for residual ovarian syndrome. This study aimed to evaluate the clinical, intraoperative and his­topathological characteristics of ROS.
Methods: This was a retrospective study done in the Department of Obstetrics and Gynecology, TUTH. Seventeen cases of ROS that were identified to have undergone relaparotomy from year April 2015 to March 2020 were studied. Review of documents was done to find out the cause of hysterectomy and preservation of ovaries. Operative/pathological characteristics of mass along with operative complications were accessed. Data was entered and descriptive analysis was done in SPSS 24 software.
Results: Total of 17 patients who underwent relaparotomy for ROS was identified. Most common presentation was abdominal pain(53%) and most patient(41%) presented with ROS within five years of hysterectomy. Pelvic adhesions were seen in almost 94% of the cases. One case sustained bladder injury. However, DJ stenting was done in 4 cases as precaution. Eighty two percent mass were benign in nature whereas 18% were malignant.
Conclusions: Relaparotomy in cases with ROS has a vital role. Though intraoperative complications like adhesions are encountered, it helps to diagnose the pathology of the symptomatic residual mass for the further management of the case.
KNOWLEDGE REGARDING PAIN MANAGEMENT AMONG NURSING STUDENTS OF BUTWAL SUB-METROPOLITAN CITY OF RUPANDEHI DISTRICT, NEPAL
Authors: Bhattarai Sigma , Ghimire Sulochana , Bhusal Chet Nath , Rana Chahana
Published: May 2022

Background: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain management is an important aspect of patient care and nurses play a significant role in the acute care setting in pain assessment, treatment and management. The study was designed to find out knowledge regarding pain management among nursing students.
Methods: A descriptive cross-sectional study was conducted among 199 nursing students, select­ed by using non-probability enumerative sampling technique. A validated and pre-tested semi-structured self-administered questionnaire was used and collected data were analyzed by using descriptive and inferential statistics with Statistical Package for Social (SPSS) Software Version 20.0.
Results: This study revealed that 77.9% of the respondents had knowledge regarding meaning of pain. About21.1%, 34.7% and 70.9% of the respondents had knowledge regarding group of drug used for mild, moderate and severe pain respectively. And about 66.3%, 30.2%, 17.1%, 14.1% and 4.5% of the respondents had knowledge regarding distraction, relaxation, heat and cold applica­tion, imaginary meditation and TENS as non-pharmacological measures used for pain manage­ment respectively. The findings of the study revealed that 47.7% had low knowledgeregarding pain management.
Conclusions: Nearly half of the students had low knowledge regarding pain management. It is rec­ommended to nursing colleges to give more emphasis on assessment of pain and its management and increase practical exposure.
STUDY OF METABOLIC SYNDROME IN SCHIZOPHRENIC PATIENTS TREATED WITH ANTIPSYCHOTICS
Authors: Subedi Anil , Lamichhane Ram Prasad , Khattri Jai Bahadur
Published: May 2022

Background: There are limited data on the prevalence of metabolic side effects with the anti­psychotic drugs in Nepal. The objective was to study the prevalence of metabolic syndrome in schizophrenia patients treated with antipsychotics drugs. The second objective was to test the relationship of metabolic syndrome with different socio-demographic and clinical variables
Methods: This was hospital based cross sectional study conducted in the outpatient’s unit of De­partment of Psychiatry, Manipal Teaching Hospital, Pokhara. Ethical approval was taken from the Institutional Review Committee of Manipal College of Medical Sciences, Pokhara. A total of 60 patients (age between 16 and 65 years) who had fulfilled the diagnostic criteria of schizophrenia according to International Classification of Disease – 10 guidelines and who had taken a single antipsychotic drug for at least 6 months were enrolled after taking informed written consent. Data were collected from April 2020 to July 2020.Patients were diagnosed to have metabolic syndrome according to adapted National Cholesterol Education Program Adult Treatment Panel III criteria by the American Heart Association (NCEP ATP III-A). Data entry and analysis was done using SPSS ver­sion 16.0. The statistical method used were percentage and chi-square test.
Results: The prevalence of metabolic syndrome was 30%. There was association of metabolic syn­drome with socioeconomic status. There was no statistical association of metabolic syndrome with gender, residence, type and duration of antipsychotics use.
Conclusions: The prevalence of metabolic syndrome was high. Therefore, proper monitoring of metabolic syndrome and adequate treatment of cardio-metabolic risk factors are required for op­timum long-term management.
COLOUR VISION DEFICIENCY AMONG MEDICAL STUDENTS OF CHITWAN
Authors: Bhusal Pujan , Timilsina Sameer , Yadav Ram Lochan , Sapkota Niraj Khatri , Islam Md Nazrul
Published: May 2022

Background: Colour vision is the function of three types of cone pigments present in the retina. Though colours are used for important signs in the medical profession, screening for colour blindness is not paid attention at beginning of a medical career. This study was aimed to assess the presence of colour blindness, if any among the medical students of Chitwan Medical College.
Methods: A total of 220 medical students including 127 females and 93 males aged between 16-24 years were examined for colour blindness. Students were shown the complete range of Ishihara’s plates under daylight conditions. The chart was held 75 cm away from the subjects. The types of colour vision deficiency were differentiated with help of key provided with the chart. The data was analyzed by using Statistical Package for the Social Sciences version 20.
Results: Among 220 participants, 5(2.27%) were found to have colour vision deficiency. Out of 5colourdeficient students, 4of them were red-green colour vision deficient and 1 of them couldn’t appreciate colour (total colour blindness) within the speculated time for the test. Female partici­pants didn’t have colour vision deficiency while colour vision deficient students were unaware of their colour vision status.
Conclusions: Colour vision deficiency affects male than female. Medical students should be screened for colour vision deficiency and made aware of their limitation so that they can take special care in their future clinical practice.
ASSOCIATION OF LIVER FUNCTION TEST PARAMETERS WITH HEMATOLOGICAL INDICES IN SEROPOSITIVE HEPATITIS B PATIENTS
Authors: Timalsina Santosh , Sandesh Nepal  , Shishir Mahato
Published: May 2022

Background: Inflammation is increasingly being implicated for progression of Chronic Hepatitis B. Besides the usual liver function test (LFT) parameters, systemic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have generated significant interest that could be useful in stratifying the severity and prognosis of liver disease. The aim of this study was to compare LFT parameters and hematological ratios (NLR and PLR) between seropositive hepatitis B patients and healthy controls and explore associations between them.
Methods: This cross-sectional study included 64 Hepatitis B surface antigen (HBsAg) positive patients and 62 apparently healthy seronegative individuals visiting Chitwan Medical College between March to October 2019. Laboratory data included standard LFT panel and hematological parameters including NLR and PLR. Data was analyzed using SPSS software, version 20. P<0.05 was considered to be statistically significant.
Results: The two groups (seropositive and seronegative group) did not differ by age and gender. LFT parameters except for total protein were higher in the seropositive group. Both median NLR and PLR were considerably lower in the seropositive group compared to the seronegative group (2.99 and 102.32 vs. 3.67 and 126.15 respectively). However, NLR showed a considerable overlap between the groups, indicating a high variability. No significant correlation was observed between these hematological indices with other LFT parameters.
Conclusions: NLR and PLR are easily obtainable, cost-effective parameters that are inversely related with Hepatitis B infection. They could supplement routine LFT parameters in characterization of the phase and severity of chronic Hepatitis B infection.
MANDIBULAR BODY OSTEOTOMY FOR SKELETAL CLASS III MALOCCLUSION: A CASE-BASED REVIEW
Authors: Kumar Singh Ashutosh , Sah Jitendra , Dhungel Safal , Yadav Manish
Published: May 2022

Mandibular step body osteotomy has been out of favour since more stable ramus osteotomies were refined and used for jaw deformities. Mandibular body osteotomy still has certain indications for which it is preferable over ramus osteotomies. Mandibular body osteotomy is best suited to correct prognathism caused by mandibular body excess with a retained tooth or in presence of extraction space, with good posterior occlusion, when ramus osteotomies and setback will lead to loss of the last tooth and non-obtuse gonial angle. Other indications are apertognathia, mandibu­lar asymmetry and small advancements of the anterior mandible.
Here we present a case 24 year male with a skeletal class III malocclusion managed with an intra­oral mandibular step osteotomy and setback of 8 mm. One-year followup has shown minimum neurosensory and odontogenic complications associated with mandibular step osteotomy and very high satisfaction among the patient. We also present a brief review of the indications, modifi­cations and refinement of the technique and summarize current published clinical usage.
This is a very stable osteotomy with favourable fracture pattern and does not involve stripping or change in position of muscles of mastication thereby ensures long term stability and minimal risk of relapse. This surgery also has minimal effect on airway narrowing compared to the ramus osteotomy setback. For some specific indications not suited to a sagittal split ramus osteotomy, mandibular body step osteotomy still has relevance and usage.
GINGIVAL DEPIGMENTATION AND PINK AESTHETICS: A CASE REPORT
Authors: Kafle Shristi
Published: May 2022

The colour of gingiva has a tremendous impact on the overall aesthetics of an individual. Clini­cally, gingival melanin hyperpigmentation is presented as ‘black gum’, which is a common aesthetic problem especially for those who have a gummy smile. It mainly affects the self-esteem, appear­ance, and confidence of an individual, and it can also have a psychological impact on many pa­tients. Gingival depigmentation can be carried out as part of its treatment using various methods. A case is reported here where scalpel surgery was performed.
FILICIDE-SUICIDE: A CASE REPORT ON TRIPLE HANGING
Authors: Parajuli Sudhir Raman
Published: May 2022

Dyadic deaths involve deaths that occur when two or more persons die together or one after another in the same incident. Filicide-suicide is a variant of homicide-suicide which includes the killing of children by a parent. We bring here a rare case of a father with his two children found hanging in a shed with a use of single ligature material, nylon rope. The children were of age three and five years. It happened when wife of the man had run away with another man leaving them behind for 15 days.
FACTORS PREDICTING FAILURE OF EMPIRICAL ANTIBIOTIC THERAPY IN NEONATAL SEPSIS IN THE FIRST ONE WEEK OF LIFE
Authors: Gauchan Eva , Basnet Sahisnuta , Malla Kalpana Karmacharya
Published: May 2022

Background: World Health Organization recommends ampicillin and gentamicin as empirical antibiotics for treatment of neonatal sepsis. However not all neonates respond to the empiri­cal antibiotics. This study was conducted to find out the risk factors associated with treat­ment failure to these antibiotics so that alternative antibiotics can be started at the outset to ensure a successful discharge from hospital.
Methods: A prospective, observational study was conducted in the neonatal intensive care unit of a tertiary-level hospital of Western Nepal from January 15 2019 to January 14 2020. Neonates < 7 days old with neonatal sepsis were enrolled into the study. Babies who died or whose antibiotics were changed from the empirical antibiotics to second-line antibiotics within 48 hours were classi­fied as treatment failure. Various parameters were compared between the treatment failure group to the group who did not fail on the empirical antibiotics. Binary logistic regression analysis was carried out keeping treatment failure as the dependent variable and various independent variables were identified which predicted the chances of treatment failure.
Results: Out of 173 neonates admitted for sepsis, 19 (11%) developed treatment failure. Binary logistic regression analysis found 5 min Apgar <7 (p-value=0.005), need for vasoactive support (p-value= <.001) and culture positivity (p-value= 0.009) correctly predicted treatment failure.
Conclusions: In presence of Apgar score <7 at 5 minutes, need for vasoactive support and culture positivity, it would be beneficial to start alternative antibiotics according to the local microbiologi­cal flora to minimize complications and ensure better outcome.
PHYSICAL ACTIVITY STATUS AMONG HEALTH SCIENCE STUDENTS OF CHITWAN, NEPAL
Authors: Adhikari Kishor , Neupane Sadikshya , Sapkota Sachin , Khanal Gayatri
Published: May 2022

Background: Physical inactivity has become a major public health concern in todays’ world. Evidences suggest that nearly one-fifth of the overall risk for coronary heart disease, type 2 diabetes, breast cancer, colon cancer is due to physical inactivity. The aim of present study is to assess the physical activity status among health science students in Chitwan District of Nepal.
Methods: Present study is a cross-sectional study conducted among health science students of Chitwan District identified through non-probability sampling technique. Ethical approval was ob­tained from CMC IRC. Information on physical activity was gathered using the self-reported Global GPAQ – 16 items. A final activity response from each student was summed into MET/minutes per week, which was further classified as: inactive, low active, moderately active and highly active in terms of total MET minute/week. Descriptive and inferential analysis was done through this IBM SPSS software version 20.
Results: More than two-third of students reported their status as low active. Nearly 7% were physi­cally inactive. About 93% of the health science students met the minimum WHO recommendation for physical activity (≥600 MET-minutes/week). The difference on physical activity status according to gender and age groups was found statistically significant (p<0.005).
Conclusions: There was huge proportion of students with low level of physical activity. There is need for focusing on health information system to aware public regarding the importance of physi­cal activity.
DOMESTIC VIOLENCE AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINICS IN MADI MUNICIPALITY, CHITWAN, NEPAL
Authors: Poudel Eak Narayan , Koirala Subash , Shrestha Niki , Khanal Gayatri , Chhetri Mamta
Published: May 2022

Background: Gender Based Violence (GBV) is a public health issue and is recognized as serious violence of human right worldwide. It is an ongoing social injustice to women. The impact of domestic violence on pregnant women is increasingly recognized as an important public health issue that has serious consequences for their physical and mental health. Hence the present study aimed to explore prevalence and predictors of Gender Based violence.
Methods: The hospital based cross-sectional study using face to face interview was carried out in All – Healthcare Centers of Madi Municipality of Chitwan District, Nepal. 215pregnant women attending Antenatal clinics (ANC)were selected for study. We used Pearson’s chi-square test to investigate the effect of explanatory variables on domestic violence among pregnant women by using IBM Statistical software version 20.
Results: Among 215 pregnant women attending Antenatal clinics there were 68.4% (147) pregnant women who faced any kind of domestic violence (either sexual or physical or emotional). Result shows that the domestic violence among pregnant women differ significantly with age group(χ2=6.46, p = 0.039) , education level of respondent(χ2= 12.45, p = 0.002) , occupation (χ2=11.3, p = .001) , family income(χ2= 13.4 , p=0.014) , presence of own property (χ2= 6.80, p = 0.033) , interest for pregnancy (χ2= 14.03, p < 0.001), husband’s consumption of alcohol (χ2= 25.94 , p<0.001).
Conclusions: Prevalence of domestic Violence among pregnant women was found unacceptably high which ultimately foster risk to the mother and fetus health. Factors like age, educational level of the pregnant, family income, husband drinking alcohol habit and interest of the pregnancy among couple had profound relationship with domestic violence.
COMPARISON OF DEXMEDETOMIDINE WITH PROPOFOL FOR SEDATION IN CRITICALLY ILL ADULT PATIENTS
Authors: Subedi Deepika , Shrestha Anil , Shrestha Pramesh Sunder , Joshi Pankaj , Sigdel Shailendra , Pradhan Bishwas
Published: May 2022

Background: Patients in intensive care unit setting require invasive monitoring and treatments that often lead to anxiety and pain. To reduce anxiety, increase tolerance and improve outcome of such interventions, sedation is common practice. Propofol and Dexmedetomidine both are frequently used for sedation in ICU.
Methods: In a randomized, prospective, open label study, seventy critically ill adult patients requiring mechanical ventilation were assigned to receive either propofol infusion with 1.2 mg/ kg/hr or dexmedetomidine infusion with 0.2 mcg/kg/hr starting dose within twelve hours of intubation and titration of study drug to achieve Richmond agitation sedation score (RASS) of -2 to 0 until extubation or for seven days whichever was longer. Primary end point was percentage of time within target sedation range and secondary end points were prevalence of delirium, duration of mechanical ventilation and use of fentanyl and haloperidol.
Results: The percentage of time within target sedation range (Richmond agitation sedation score -2 to 0) was similar (p=0.947). Consumption of median dose of fentanyl (p=0.043) and haloperidol (p=0.025) were less in dexmedetomidine group. Ability to communicate pain via visual analogue scale was significantly higher in dexmedetomidine group 28 (80%) as compared to propofol group 14 (40%); p=0.001. Adverse events like hypotension, bradycardia was not significantly different.
Conclusions: Sedation with dexmedetomidine was similar as compared to propofol in mechanically ventilated critically ill adult patients. Dexmedetomidine reduced duration of delirium consumption of fentanyl and improved patients’ ability to communicate pain compared to propofol.
EFFECT OF THE COVID-19 LOCKDOWN ON ORTHOPEDIC SERVICES IN A TERTIARY HOSPITAL IN NEPAL
Authors: Sharma Bishnu Dev , Sitaula Jyoti , Neupane Gaurav , Dawadi Tej Prakash
Published: May 2022

Background: The Corona virus disease (COVID-19) pandemic has been a global health crisis and has affected Nepal also. As a strategy to control the disease outbreak, the government of Nepal had introduced a four-month nationwide lockdown. This study aims to evaluate the impact of the national lockdown in orthopedic services in Chitwan Medical College.
Methods: This cross-sectional analytical study included all the patients admitted and treated in the orthopedic department of Chitwan Medical College during lockdown period from 24 March to 21 July 2020, which was compared with the same four-month interval from 24 March to 21 July in 2019. Data collected included patient demographics, mechanism of injury, anatomical location, waiting time before surgery and hospital stay.
Results: A total of 247 patients were treated during lockdown, with a reduction of 45.4% from 2019 (452 patients). Also, there was 39.1% (340 vs 207, p=0.009) reduction in trauma cases and 35.7% (347 vs 223, p=0.000) reduction in cases operated in lockdown. There was a decrease in pediatric patients during lockdown (p=0.044). Fall was the most common mechanism of injury in both groups (p=0.158) with decrease in road traffic accidents during lockdown 27.1% (n=56) vs 45% (n=153) in 2019 (p=0.000). The waiting time before surgery and hospital stay were also shortened (p=0.000).
Conclusions: The impact of lockdown resulted in decreased number of orthopedic trauma admis­sions and cases operated. On such a crisis, only urgent and semi-urgent cases need to be managed while also protecting healthcare workers and patients
DETERMINATION & COMPARISON OF MAXILLARY FIRST PREMOLAR PULP CHAMBER LANDMARKS USING INTRAORAL PERIAPICAL RADIOGRAPH AND CONE-BEAM COMPUTED TOMOGRAPHY
Authors: Joshi Amatya Neera , Prajapati Kranti , Shrestha Suraj , Wagle Sharada
Published: May 2022

Background: Dimension and location of pulp chamber are important during access cavity preparation. It allows clinician in instruments selection, orientation and depth of cutting dur­ing the process. Analysis of these has been done in preoperative intraoral periapical radio­graph that gives two-dimensional image. The radiograph has been blamed now and then for the inaccurate results and iatrogenic damage occurred due to the inaccurate results. Cone-Beam Computed Tomography (CBCT) provides three-dimensional images and is taken as standard. Hence the aim of the study is to compare intra-oral periapical (IOPA) radiograph and CBCT to determine the landmarks for accurate results

Methods: 50 intact two-rooted maxillary first premolars were collected and numbered. Peri­apical radiograph Images and CBCT images of these 50 teeth were taken and divided as; Group I: 50 IOPAR and Group II: 50 CBCT images. Landmarks marking and measurement was done using tracing paper and x-ray viewer for IOPA images and Planmeca Romexis software for CBCT images. Data were collected and analysed with descriptive and inferential statistics by using Statistical Package of Social Science (SPSS) software version 16.

Results: The averages of group I are 7.44, 10.23mm 14.33mm, 4.1mm, 6.89mm and 2.79mm respectively. The averages of in group II are 6.95mm, 9.58mm, 14.03mm, 4.45mm, 7.07mm and 2.63mm respectively. There is statistically significant difference in measurement A and measurement B between group I and group II.

Conclusions: This indicates that there are chances of overestimation of measurement A and B with IOPAR.
SEBACEOUS HORN THAT DEVELOPED IN THE SURGICAL SCAR
Authors: Lakhey Rajesh Bahadur , Adhikari Sharad Chandra , Kafle Dinesh
Published: May 2022

Sebaceous horns are rare lesions that occur as conical projections in sun-exposed parts of the body. They are made of hyperkeratotic material and look like horns of the animals. They may har­bor benign, premalignant, and malignant lesions at their bases. We present a case of a 49-year-old lady who presented with a conical growth at the operative scar of minimally invasive open lumbar discectomy. Excision of the horn along with the base was done, and the histopathology revealed benign seborrheic keratosis, suggesting sebaceous horn.
NON-LACTOSE FERMENTERS CAUSING URINARY TRACT INFECTION AMONG DIABETIC PATIENTS AND ITS ANTIBIOTIC SENSITIVITY PATTERN: A DESCRIPTIVE CROSS-SECTIONAL STUDY
Authors: Pokharel Khilasa , Dawadi Bishwa Raj , Kushwaha Anu
Published: May 2022

Background: Urinary tract infection is the term that involves infection in any part of urinary tract. It is a severe public health problem and is caused by infection with wide range of pathogens. Increased range of recurrence and antimicrobial resistance among uropathogens causes economic burden of these infection. We here intended to find out non-lactose fermenters causing urinary tract infection.
Methods: The descriptive cross-sectional study was conducted at Microbiology laboratory of Kathmandu Medical College and Teaching Hospital between the month of 1st August, 2020 till 30thJanuary, 2021. Clean catch midstream urine was collected in a wide mouthed leak proof sterilized container. Culture and bacterial identification were done using standard microbiological guideline. Antibiotic sensitivity test was performed by Kirby-Bauer disc diffusion method following clinical and laboratory standards institute (CLSI) guidelines.
Results: Among 2645 samples, 418 (15.80%) were positive for bacterial infection. Out of 418 positive cases 52 (12.44%) were non-lactose fermenters. Among non-lactose fermenters causing Urinary tract infection the most common organism was Acinetobacter species 17 (32.69%) which was more sensitive to Ofloxacin 58.82% followed by Gentamycin, Amikacin and Imipenem 47.05%.
Conclusions: The most common non-lactose fermenter causing urinary tract infection among diabetic patients was Acinetobacter species which is more sensitive to Ofloxacin.
SPECTRUM OF ORAL LESIONS IN A TERTIARY CARE CENTRE OF NEPAL
Authors: Acharya Sudeep , Pradhan Amita , KC Shivraj , Mahato Moni , Acharya Sandhya Chapagain
Published: May 2022

Background: Lesions in the oral cavity may be of variety of types. Their trends are also in­creasing day by day. The aim of the study was to determine the spectrum of oral lesions reporting at the tertiary care center in Nepal.
Methods: A retrospective study was conducted among from the medical records among the sam­ples sent for biopsy from the department of Oral and Maxillofacial Surgery at KIST Medical College from a period of 2008 to 2017 AD. The data was entered into excel and transferred into SPSS ver­sion 16 and analyzed using descriptive statistics presented in the form of table.
Results: A total number of 84 cases were include into the study. Age of the patients were ranged from 7 to 87 years. Oral mucosa was the most common site followed by tongue. The most com­mon lesion reported was pyogenic granuloma followed by well differentiated oral squamous cell carcinoma.
Conclusions: The majority of the oral cavity lesions are diverse in nature. All lesion especially in the oral cavity should be biopsied to rule out malignancy. Diagnosis of any of these rare lesions is important from the management point of view.
PREVALENCE OF METABOLIC SYNDROME AND ITS COMPONENTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE TEACHING HOSPITAL
Authors: Timalsina Santosh , Pandit Pratima
Published: May 2022

Introduction: The metabolic syndrome (MetS) is a cluster of risk fac­tors that is responsible for most of the excess cardiovascular morbidity amongst patients with Type 2 Diabetes Mellitus (T2DM). Presence of MetS in T2DM markedly increases the risk for coronary heart disease, stroke and premature deaths. This study was undertaken to find the prevalence of MetS and its individual components among patients with T2DM visiting Chitwan Medical College and Teaching Hospital, Bharat­pur, Nepal.

Methods: A laboratory-based descriptive cross sectional study carried out at CMC-TH between January and August, 2017. Data obtained in­cluded anthropometric indices, blood pressure and fasting serum lipid profile. National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria were used for diagnosis of MetS. Data was ana­lyzed using SPSS version 20.

Results: The overall prevalence of MetS among 150 T2DM patients (Mean age= 53.70±10.83 years, Male:Female=84:66) was 60%. The prev­alence was higher in females compared to males (75.75% vs.47.62%, P<0.001). High blood pressure was the commonest MetS component. Following that, decreased HDL-c was the predominant component in females whereas raised triglyceride in the males. SBP/DBP, BMI and waist circumference were significantly associated with MetS.

Conclusion: The prevalence of MetS is high in diabetic patients, particu­larly in females and middle age group adults, with high blood pressure and hypertriglyceridemia as the commonest abnormalities. As MetS adds to the cardiovascular risk to the already at-risk diabetic popula­tion, timely identification and appropriate intervention is of utmost im­portance in reduction of disease burden in T2DM patients.