bluuebunny/crossref_metadata_2025 huggingface dataset:
Pattern of Cleft Lip and Palate According to Gender in Children of Bangladesh
Authors: Fatema Sharmin , Ashrafuzzaman Md , Mostofa Asma , Ayub Ali Md , Reza Rumela
Published: November 2024

Background: Cleft defects are the most common congenital anomalies of the orofacial region. The typical distribution of cleft type is cleft lip, cleft palate and combined cleft lip and palate. To determine the frequency of Cleft Lip (CL), Cleft Palate (CP) and combined cleft lip and palate (CLP) according to gender. Materials and methods: It is a cross sectional observational study with some analytical components which was carried out in the Department of Anatomy of Chittagong Medical College From April 2021 to March 2022. It was conducted among 100 children of cleft lip and palate. Data was collected from LMRF (Lions Mukhlesur Rahman Foundation) Children Hospital, Smile train (CMSOGH) cleft project and Chattogram Maa Shishu O General Hospital, Agrabad Chattogram. The data were recorded in a predesigned questionnaire. Variables were presented as percentages (%) and were compared by Chi-Square test. All statistical analysis were performed using SPSS statistics for Windows, version 26.0. Finally the results were presented using tables and figures. Results: Among the 100 participants there were 58 male and 42 female children with a ratio of 1.38:1. 68% had combined cleft lip and palate, 22% had isolated cleft palate and only 10% had isolated cleft lip. Among the 10 children with cleft lip 4 were male and 6 were female. 80% of the cleft lip was on the left side. Among 22 children of cleft palate 9 were male and 13 were female. Lastly among 68 children of cleft lip and palate 45 were male and only 23 were female. 44% of cleft lip and palate was on the left side, 32% bilateral and only 24% was on the right side. Conclusion: This study reported the pattern of cleft defects with gender distribution in our country which shows females are more likely to have isolated CL and CP and males have CLP predominantly.
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 3-7
Socio-Demographic and Clinical Profile of COVID-19 in Children
Authors: Islam Sanjana , Hasan Reza Fahim , Ara Begum Gulshan , Ayman Radia Umme , A Chowdhury Arju Mahmood
Published: November 2024

Background: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is a global pandemic. Infection by COVID-19 in children is not so common but gradually the numbers of children affected with COVID-19 are increasing day by day. Covid-19 has spread around Bangladesh and children are also being infected with comparatively fewer symptoms and lower case-fatality rates. To describe the epidemiological and clinical characteristics of hospitalized children with COVID-19. Materials and methods: This cross sectional observational study was conducted among 154 COVID-19 children who were admitted in COVID-19 dedicated Chattagram Maa Shishu O General Hospital, Chattagram from 15 April 2020 to 21 August 2022. Their signs, symptoms, sex, age distribution, laboratory results and familial contact were analyzed. Results: Among 154 children total RT-PCR positive cases were 82 (52%) and suspected cases were 72 (47%). Among positive casesmale-female ratio was 1.78:1. Most of the children (64%) were in school going age (6-18 years).70% children were from urban area and 30% from rural area. Most of the children (78%) came from middle and upper middle socioeconomic group and 22% from lower socioeconomic group. About 74% children were affected from family member.Main symptoms of the children were cough (72%), and fever (62%), fever with cough (56%) and diarrhoea (26%). About 58% of the children had additional symptoms including sore throat, nasal congestion, fatigue, headache, body ache, vomiting, abdominal pain, 32 patient came with shortness of breath. 7 patients had comorbidities. Among those 1 with CKD, 1 CP, 2 TB and 3 patients had asthma. Total 6 patients were died, 2 patients from positive cases and 4 patients from suspected cases. Among those 1 was CP child. About 14% patients showed lymphopenia, 14% showed leucopenia, 38% patient had neutropenia. C-Reactive Protein (CRP) and serum ferritin were high in only 52% and 38% cases respectively. There were 30% patients who had normal Chest X-Ray and 12% had bilateral consolidation and 58% had patchy opacities. Conclusion: The clinical manifestations in children are variable. However, fever and cough have mostly been profiled. Though the severe condition is rarely reported in children compared with adults, life-threatening complications, and death associated with COVID-19 disease have been documented. But it is evident that they may play a role in transmission of disease.
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 14-17
Clinical Profile of Patchy Alopecia: Report from a Tertiary Care Hospital of Bangladesh
Authors: Nasrin Sultana Most , Rafiqul Mowla Mohammad , Shahriar Alam Md , Shahed Iqbal Hasan Mohammed , Nazmus Saleh Mohammed , Alam Sharmin
Published: November 2024

Background: Patchy alopecia is a common dermatological problem worldwide with a high degree of phenotypic and genotypic variation influenced by genetic and environmental factors and is often a major source of psychological distress to patients. However, there is limited published data on patchy alopecia in Bangladesh. The purpose of this study was to evaluate the clinical pattern and prevalence of patchy alopecia in Bangladeshi patients. Materials and methods: This is a descriptive cross-sectional study which was carried out in the Department of Dermatology and Venereology of Chittagong Medical College Hospital, Bangladesh, between the periods of September 2018 to December 2019. Results: Out of 259 patients, male were 169 (65.3%) and female were 90 (34.7%) with a male to female ratio 1.8:1. The mean age of the study population was 23.73 ± 12.735 SD (Range: 1-65) years. The mean age of onset was 22.67 ± 12.735SD (Range: 0-65) years. Non Cicatricial Alopecia (NCA) were accounted 192 (74%) and rest of the 67 (26%) were Cicatricial Alopecia (CA) patients. Alopecia Areata (AA) 172 (66.4%) was the most common 192 (74%) NCA while alopecia due to Discoid Lupus Erythematosus (DLE) 34(13.1%) was the most common 67 (26%) CA. Most of the patients 158 (61%) had multiple patches. Among 259 patients, 77 (29.73%) patients had associated pruritus, 44 (16.98%) patients had scaling and 49 (18.9%) patients were atopic. Conclusion: This study finding showed that patchy hair loss results from a variety of causes. Proper identification and differentiation of pattern of patchy alopecia is necessary for early diagnosis and to design appropriate treatment and by all these means to improve the quality of life
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 27-30
Correlation between Clinical and Endoscopic Findings in Patients with Dyspepsia at a Tertiary-Care Hospital of Bangladesh
Authors: Muslehuddin Shahed Mohammad , Anwarul Azim Md , Mohajan Monisha , Shankar Roy Biswas Rajat , Yusuf Muhammad
Published: November 2024

Background: Dyspepsia is a prevalent symptom worldwide, affecting 7%-34.2% of populations, and has a significant impact on patients and healthcare systems. The study aimed to investigate the relationship between clinical and endoscopic findings to improve cost-effectiveness in endoscopy. Materials and methods: This observational study was conducted at the Department of Gastroenterology, Chattagram Maa-O-Shishu Hospital Medical College (CMOSHMC) over a period of 34 months from January 2020 to October 2022. Study population was patients aged 18 years and above with dyspepsia symptoms referred from various departments of this hospital for upper gastrointestinal tract endoscopy. Results: The study involved 705 patients, with the largest age group experiencing dyspepsia symptoms being 28-37 years old (25.5%). Dyspepsia was more prevalent in patients below 57 years old (83.1%) compared to those above 57 years old (16.8%). Females had a higher incidence of dyspepsia than males, with a ratio of 1.9:1. Abdominal pain was the most common symptom (43.96%). Endoscopic findings included peptic ulcers (14.6%), gastric ulcer (8.36%), duodenal ulcer (6.24%), gastritis (32.48%), oesophagitis (13.33%), gastric carcinoma (1.84%), and normal results (34.60%). Female gender was associated with normal endoscopic findings (p<0.05). Conclusion: The study concludes that both uninvestigated and functional dyspepsia was more prevalent in females. Abdominal pain was the most common complaint followed by abdominal burning. The study also revealed that prevalence of functional dyspepsia decreases with age, giving way to organic lesions. Gastritis was a frequent endoscopic finding; however, its clinical relevance is uncertain><0.05). Conclusion: The study concludes that both uninvestigated and functional dyspepsia was more prevalent in females. Abdominal pain was the most common complaint followed by abdominal burning. The study also revealed that prevalence of functional dyspepsia decreases with age, giving way to organic lesions. Gastritis was a frequent endoscopic finding; however, its clinical relevance is uncertain.
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 31-35
Nomograms of Liver, Spleen and Kidney Dimensions Based on Ultrasonographic Measurements
Authors: Qumrul Ahasan Md , Kabir Chowdhury Tanvir , Sadab Durdana , Tahera Aziz Tasmiah , Banu Tahmina
Published: November 2024

Background: For Liver, spleen and kidney measurement, available data are not always representative for all population. This study was aimed to find out the normal measurement of kidney, liver, spleen using ultrasonography at Chattogram, Bangladesh. Materials and methods: Among a total of 3699 subjects (Male: Female 1.4:1; median age 35 years) without any liver, splenic or renal diseases ultrasonographic images of these organs were from 2780, 1596, and 2780 individuals respectively. Measurements were taken for liver length, splenic length and breadth and renal length, breadth and cortical thickness. Results: The average liver length in neonates and infants were 5.2 and 6.5 cm in females and 5.7 and 6.6 cm in males. After 20 years of age, average liver sizes ranged from 11.1 to 11.6 cm. The average spleen length in neonates and infants were 3.5 and 5.6 cm in females and 5.7 and 6.4 cm in males. After 20 years of age, it ranged from 8.2 to 9.0 cm. The average renal length in neonates and infants were 4.2 and 5.3 cm for right kidney and 4.3 and 5.5 cm for left kidney in females. In male neonates and infants were 4.9 and 5.3 cm for right kidney and 4.8 and 5.6 cm for left kidney. After 20 years of age, it ranged from 9.0 to 9.7 cm for right kidney and from 9.6 to 10.2 cm for left kidney. Conclusion: These values may be used as reference for normal liver, spleen and kidney dimensions for populations of Chattogram, Bangladesh.
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 36-41
Demographic, Clinical and Biochemical Characteristics and Phenotype of Children with Chronic Hepatitis B in a Tertiary Care Hospital
Authors: Rahman Munmun Sayma , Bazlul Karim ASM , Datta Mitra , Siddiqua Ayesha , Nahar Kamrun , Nahar Luthfun , Mondal Mohuya
Published: November 2024

Background: Chronic hepatitis B is a disease of global burden. Variable range of presentations and different phenotypes has made the disease unique and produces difficulties in diagnosis of the disease. This study aimed to identify the varying clinical presentation and phenotype of chronic hepatitis B in children. Materials and methods: This cross-sectional observational study was conducted at Paediatric Gastroenterology and Nutrition Department in BSMMU, Dhaka, Bangladesh, from January, 2018 to June 2019. Total 70 children of chronic hepatitis B were studied. Detailed history, clinical examinations and investigations such as CBC, liver function test, HBsAg, HBeAg, Anti HBe Hepatitis B virus DNA were done for all patients. Their phenotypes were determined. Results: Among total 70 patients about half of the patients were in the older age group and (68.6%) were male. Clinically about (68.57%) were asymptomatic. Among the symptomatic patients common presentations were anorexia/nausea/vomiting (28.6%), abdominal pain (27.1%), hepatomegaly (12.8%), jaundice (10.0%), Spleenomegaly (5.72%). Majority of them were biochemically normal. Serum ALT and S. AST was raised only in (34.3%) and (31.4%) respectively. HBeAg was positive in (61.4%) patients. Phenotypic presentation revealed immune tolerant 45.7%, immune active 20.0%, inactive carrier 20.0%, another 14.3% patients were in the HBeAg negative phase. Conclusion: Majority of the children with chronic hepatitis B were clinically asymptomatic, biochemically normal and phenotypically in the immune tolerant phase. But an important number of children showed feature of active hepatitis
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 42-46
A Programmed Labour to Optimize Labour Outcome
Authors: Yeashmin Munthasir , Noor Serajun , Akhter Salma
Published: November 2024

Background: A Programmed labour following a protocol teaches the goal of safe motherhood. The present study on programmed labour protocol implemented to shorten the duration of labour, to optimise pain relief during labour, to monitor labour by partograph and to enhance vaginal birth. The prime objective of the study is to evaluate the effect of programmed labour on duration of labour and to assess efficiency of analgesics in reducing severity of labour pain. Materials and methods: Total 100 cases of low risk pregnant women both primi and multipara were included in this study. It was designed to low risk pregnant women with cephalic presentation without evidence of CPD- either with spontaneous onset of labour or waiting for induction of labour at 41+ wks pregnancy. Patient with labour pain allowed to move. Pain relief was done either by pharmacological or nonpharmacological method. Labour was monitored by partograph. Results: The duration were shortened in all stages of labour specially in active phase that was (Mean± SD- 3.08 hr ± 0.83), Significant paint relief in 76% cases (Mean SD of score 2.08 ± 0.62). The rate of vaginal delivery is more in programmed labour which is about 95% in this study. There is also significant reduction of maternal and fetal morbidity and mortality. Conclusion: The programmed labour is simple, easy, cheap and effective method of painless and safe vaginal delivery. Significant reduction of pain by programmed protocol avoid hyperventilation of mother, maintain circulation, thereby increase chance of vaginal delivery.
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 72-74
Demographic Profile and Upper Gastrointestinal Endoscopic Findings among Children with Gastrointestinal Symptoms
Authors: Anwarul Azim Md , Musleh uddin Shahed Mohammad , Yousuf Muhammad
Published: November 2024

Background: Upper endoscopy is an essential, safe and sensitive tool for diagnosing pediatric gastrointestinal issues. In Bangladesh, the practice of pediatric endoscopy remain rudimentary due to lackoftrained pediatricendoscopist. There is limited study on pediatric upper GI endoscopy in our country. The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children. Materials and methods: This is a retrospective study, the medical records of all patients whose age is under 18 years and who underwent upper GI endoscopy in last 2 years were included. Results: Among the total of 150 children (Age <18 years), the most common indications were recurrent abdominal pain in 95 (63.3%) patients followed by Vomiting 26(17.33%), hematemesis 22(17.67%), dysphagia 4(2.7%), jaundice 3(2%). In almost half of the patients 75 (50%), the endoscopic findings were normal. The most common abnormal endoscopic findings were esophagitis seen in 42(28%) of patients followed by 18(12%) cases of superficial gastritis, duodenal ulcer 5 (3.3%), esophageal varix 4(2.6%), gastric polyp 3 (n=2%), antral gastritis 1(0.7%), biliary ascariasis 1(0.7%), esophageal ulceration 1(0.7%). Conclusion: The commonest indication for Pediatric UGI endoscopy was recurrent abdominal pain and the commonest endoscopic feature was esophagitis. No significant post procedure complication was noted in this study.
Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 75-78
Socioeconomic Determinants of Inequalities in the Use of Modern Contraception among Currently Married Women
Authors: Pokhrel Taranath , Aryal Kabita , Adhikari Ramesh , Dulal Bishnu Prasad , Karki Deepak Kumar , Dahal Harsha Raj , Dangol Milima Singh , Poudel Pradeep , Bhattarai Navaraj , Lamichhane Prabhat
Published: November 2024

Background: Despite interventions for over four decades, the unmet need for family planning is high in Nepal. This study aims to examine the status and the socioeconomic determinants of inequalities in modern contraception among currently married women.Methods: We applied a mixed-method design. We interviewed key informants for qualitative information and analyzed secondary data from the Nepal Multiple Indicator Cluster Survey, 2019, and different rounds of Nepal Demographic and Health Surveys. We calculated ratios, differences in percentages, and concentration indices to analyse the inequality. We ran a binary logistic regression model to estimate the adjusted effect of each factor on the use of modern contraception. Results: The richest-to-poorest difference in using modern contraception has decreased over 13 years. The richest-to-poorest difference decreased from 23.6 percentage points in 2006 to 13.3 percentage points in 2011 and further to 1.2 percentage points in 2016. The richest-to-poorest difference was negative in 2019, indicating poor people are using more contraception than the richest. Multivariate analysis showed the wealth is a significant predictor for using contraception. Women of richer households (aOR=1.29, 95% CI=1.13-1.48), middle (aOR=1.21, 95% CI=1.05-1.40), poorer (aOR=1.36, 95% CI 1.17-1.58) and poorest (aOR=1.18, 95% CI=1.05-1.34) were more likely to use contraception than women from the richest households. Conclusions: Poor people are increasingly using the modern contraception, and the gap between the poor and rich people has decreased. However, the trend of contraception use in each wealth quintile indicates that Nepal struggles to meet the sustainable development goal target of reducing the unmet need for family planning to less than 10% by 2030.Keywords: Contraception; inequalities; married women; nepal; wealth status.
Barriers to Utilization of Postnatal Care Services: Mothers and Health Providers Perspective
Authors: Shrestha Jene , Yadav Dipendra Kumar
Published: November 2024

Background: Access to and utilization of post-natal care services is a major challenge as the majority of maternal deaths occur during post-natal period. Although geographical factors and access to health facilities in urban area are feasible as compared to rural area the utilization of all three postnatal visits remains low. Hence, this study aims to explore the barriers in utilization of postnatal care services by mothers from the perspective of mother’s and health service providers as well. Methods: A qualitative study was done using community- based exploratory design in urban area of Kathmandu district. In-depth interview with mothers with infants above 45 days to 1 year of age and key informant interviews with health care providers were done using interview guidelines. Thematic analysis was done.Results: Seven themes emerged through thematic analysis, which were further classified into category and sub categories. Poor recording and reporting system, poor health communication, postnatal care visits less prioritized among maternal health services, prerequisites to construction, and postnatal care services/information dependent on female community health volunteer, less utilization of mass media, and perception of people were identified as barrier for utilization of postnatal services.Conclusions: The common reason for non-utilization of postnatal care service is identified as poor health communication that resulted in lack of knowledge on the benefit and timing of postnatal care. Lack of awareness among women on postnatal care services shows lack of effort in making postnatal care related information easily available and accessible. Hence, education and awareness on postnatal care services along with proper therapeutic communication is seen essential to complete the continuum of care in maternal health services.Keywords: Barriers; health Personnel; non- utilization; postnatal care; qualitative
Association of Prevalence of Dental Caries in Mandibular Second Molar with Impacted Third Molar
Authors: Kunwar Deepa , Koirala Ujjwal , Manandhar Archana , Subedi Sushil , Gurung Nisha
Published: November 2024

Background: An impacted tooth is a tooth which does not reach the occlusal plane even after two-thirds root formation. Conditions associated with impacted teeth include trismus, cystic lesions, and cervical caries of second molars. The objective of this study was to evaluate the occurrence of carious lesions in the distal aspect of the mandibular second molar and its association with the presence of mandibular third molars. Methods: A cross-sectional study was conducted from September 2018 to September 2020. Approval was taken from the Institutional Review Committee with reference number 90/77/78. Orthopantomograms of patients aged 18 years or older were studied. Information on age, gender, mandibular second and third molars were recorded. Convenient sampling was done. Statistical analysis was done using Statistical Package for Social Sciences version 21. Results: A total of 626 radiographs were studied of which mesioangular impaction (35.3%) was the most prominent type and followed by horizontal impaction, causing distal caries in second molars. The age group between 20-40 years and female gender had the higher prevalence of distal caries in second molar teeth. There was a significant correlation between gender and cavity existence (p=0.00), between impaction and existence of decay (p=0.00), and depth of impaction with cavity formation (p=0.004).Conclusions: A total of 31.8% of the patients with impacted mandibular third molars had distal cervical caries in second molars. Mesioangular type, female gender, type A were the prominent factors associated with distal caries in second molar teeth due to impacted third molars.Keywords: Impacted tooth; mandible; molars; root caries
Association Between Erectile Dysfunction and Type 2 Diabetes Mellitus
Authors: Tamrakar Dipesh , Bhatt Dinesh Singh , Sharma Vijay Kumar , Poudyal Amod Kumar , Yadav Binod Kumar
Published: November 2024

Background: Erectile dysfunction is a distressing complication of diabetes among male patients. Despite being a serious concern affecting sexual health, the issue regarding sexual dysfunction is seldom discussed by patients with physicians in developing countries. This study aimed to identify the prevalence of Erectile dysfunction and its association with other risk factors among type 2 Diabetic males attending the tertiary care hospital in Nepal.Methods: A cross-sectional hospital-based study was carried out in the Diabetes Out Patient Department of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. 160 male patients with a history of Type 2 Diabetes Mellitus (T2DM) meeting the inclusion criteria were enrolled in the study with informed consent. A validated questionnaire; an abridge 5 item version of the International Index of Erectile Function (IIEF 5) was used to assess the erectile function where the score below 22 was considered as having erectile dysfunction. The severity of erectile dysfunction was categorized based on IIEF 5 score.Results: The prevalence of erectile dysfunction with varying degrees of severity was found to be 76.87% among T2DM male patients. There was a significant negative correlation of the IIEF5 Score with the duration of T2DM burden (r= -0.416, p<0.05) and the level of HbA1c (r= -0.391, p<0.05).Conclusions: There was a higher prevalence of erectile dysfunction among T2DM male patients that were also associated with poor glycemic control and the duration of T2DM burden.Keywords: Erectile dysfunction; international index of erectile function; type 2 diabetes mellitus
Ovarian Carcinoma in a Young Pregnant Woman
Authors: Singh Jitendra Kumar , Dangal Ganesh , Karki Aruna , Pradhan Heema Kumari , Shrestha Ranjana , Bhattachan Kabin , Paudel Rekha , Bajracharya Nishma , Tiwari Kenusha Devi , Bharati Sonu
Published: November 2024

Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to the lack of randomized trials and cohort studies. A case of 28 years female, from Kathmandu, visited Out-Patients Department with complaint of amenorrhea for 8 weeks associated with nausea and occasional pain abdomen. Dating scan was done which showed a single live intrauterine pregnancy corresponding to 8 weeks 4 days of gestation with incidental finding of adnexal cysts in both adnexa, measuring 3.6 x 3.6 cm on right and on left 3.2 x 3.6 cm. The cysts did not show any septations. At 38 weeks, she underwent caesarean section and delivered a healthy baby girl. Intra-operatively, bilateral ovarian cysts were identified, both 2x2 cm simple-looking cysts. Enucleation of bilateral ovarian cysts was done. The specimen was sent for histopathology which showed serous carcinoma of low grade in bilateral ovaries. Staging surgery was then carried out after 6 weeks. Histopathology report showed serous carcinoma of low grade in both ovaries. We present here the case of ovarian cancer during pregnancy.Keywords: Ovarian cancer; pregnancy
Safety and Efficacy of Single vs Dual Antiplatelets Therapy After Atrial Septal Defect Device Closure
Authors: Adhikari Chandra Mani , Prajapati Dipanker , Bogati Amrit , Acharya Kiran Prasad , Acharya Anjana , Shahi Roshani , Shrestha Swikirty , Ghimire Vijay , Thapa Kavindra , Sherpa Kunjang
Published: November 2024

Background: Atrial septal defect device closure has become a standard procedure. Antiplatelet therapy is used to prevent thrombus formation in the device. There is no clear recommendation about the antiplatelets drugs. This study aims to evaluate the safety and efficacy of Aspirin vs (Aspirin +Clopidogrel) after device closure. Methods: A cross-sectional study was conducted among all consecutive adult patients (?18 years) who underwent atrial septal defect device closure from May 2019 to April 2020 and meet the inclusion criteria were included. After successful ASD device closure patients were treated with ASA or combination of ASA and Clopidogrel for six months on physician discretion. Patients were followed up for six months to observe for Transient ischemic attack, Stroke, thrombus in the device, myocardial infarction, major bleeding, minor bleeding and increases in headache episodes compared to baseline.Results: This study consisted of 130 patients: 65 in the Aspirin Group, and 65 patients in Aspirin and Clopidogrel group. There was no Transient ischemic attack, Stroke, Myocardial infarction, thrombus, major bleeding in both groups. There was no significant difference between two groups in ecchymosis; Aspirin group 4(6.1%) vs. aspirin and Clopidogrel group 3(4.6%) [Difference, 1.54% {95, % CI, -1.45%to 4.53%}]; P=0.648. There was no significant difference in increase in headache episodes compared to baseline for six months after the device closure in Aspirin Group 3(4.6%) VS Aspirin and Clopidogrel group 2 (3.0%) group [difference, 1.54% {95% CI, -1.45%to 4.53%}]; P=0.648.Conclusions: Our study suggests that single antiplatelet therapy with Aspirin is as safe and effective as aspirin and clopidogrel after device closure.Keywords: Atrial septal defect; ASD device closure; clopidogrel
Perceptions of Adolescents Regarding Breast Cancer
Authors: Amatya Isha , Vaidya Abhinav , Regmi Pradeep Raj
Published: November 2024

Background: Breast cancer in women is a major health burden. In Nepal, most common cancer in female is breast cancer. Knowledge plays an important role in improvement of health seeking behavior. Knowledge may positively affect attitude and practice. So, this study aims to assess the knowledge and attitude regarding breast cancer among the adolescents. Methods: A cross-sectional study was done among students of 23 randomly selected highher secondary schools of Bhaktapur district. Total 990 participant were assessed with questionnaire regarding knowledge and attitude towards breast cancer.Results: Out of total 400 participants, 89.6% of male and 88.5% of female respondents had poor knowledge regarding breast cancer. 63.2% of the female and 50.9% of the male respondents had good attitude towards breast cancer. Religion, education of parents and ethnicity of respondents showed positive association with respondent’s knowledge of breast cancer. Gender, education and ethnicity of respondents showed positive association with respondent’s attitude of breast cancer.Conclusions: Majority of the respondents had poor knowledge and half of respondents had good attitude towards breast cancer. Therefore, educational programs and awareness campaigns that target adolescents to improve their knowledge and attitude regarding breast cancer must be encouraged. Keywords: Attitude; breast cancer; breast self-examination; knowledge
Split Versus Non-Split Morning Dosing Regimen for Assessment of Quality of Bowel Preparation for Colonoscopy
Authors: Yadav Bhuwneshwer , Basnet Bhupendra Kumar , Paudel Bidhan Nidhi , Shrestha Ramila , Khanal Ajit , Silwal Poudel Nandu , Shah Manoj , Thapa Jeewan , Baral Shankar
Published: November 2024

Background: Different bowel preparation regimens are available. Currently we are giving the entire preparation on the day of colonoscopy. Multiple studies have shown splitting the regimen might improve the quality of bowel preparation with lesser side effects and better compliance. The study was done to compare the efficacy and tolerability of split bowel preparation regimen with non-split dosing regimen.Methods: Single centered observational comparative study was done in a tertiary care hospital. One hundred ninety eight patients requiring elective colonoscopy were assigned to receive one of the two preparations (split versus morning) prior to colonoscopy. Main outcomes were bowel preparation quality and patient compliance and tolerability. Results: There was no significant difference between the two regimen for the mean total Boston Bowel Preparation Scale (6.79VS 6.74,P value -0.777).Patient compliance was better for split dosing compared to single dosing (99 vs 5 p value-<0.001).There were more side effects in the single dosage compared to split dosing except for sleep disturbance which was more in split dosing.Conclusions: The study found that split-dose and single dose polyethylene glycol solution for bowel preparation before colonoscopy had similar efficacy in the quality of bowel preparation. Split-dose polyethylene glycol appears to be superior to single-dose PEG for patient compliance and side effects.Keywords: Boston bowel preparation scale; bowel preparation; colonoscopy; split dosage preparation
COVID Stress among Nepal Police Officers
Authors: Rajbhandari Bibek , Tiwari Bhuwaneshwar , Gurung Minani , Poudel Lisasha , Adhikari Anurag , Shilpakar Olita , Puri Rajesh Raj , Singh Sumi
Published: November 2024

Background: In Nepal, the stress factor is exacerbated by a large number of police officers working away from home with less family contact, a hectic work schedule in a pandemic situation, companions suffering from illness and updates on additional cases with rising mortality rates, and a lack of access to Personal Protection Equipment. The main aim of this study was to identify the prevalence of COVID stress among Nepal police officers working during pandemic.Methods: We conducted a cross-sectional study among police officers (n=1526) working during pandemic in Province X Nepal. Semi-structured questionnaire was administered using google form. COVID Stress Scale -36 (CSS-36) was used to assess the stress in officers. Data collection was done after obtaining ethical approval. Data cleaning was done using a python script and then was exported to Ms. Excel for graph analysis.Results: The highest percentage was seen in the xenophobia subscale (24.63%), followed by contamination (20.10 %) and compulsive checking (19.21%). Comparing socio-demographic variables, 18-27 aged groups including male officers and unmarried groups had experienced high COVID stress. Conclusions: Most of the officers feared from the foreigners perceiving them the main source of COVID-19. Fears about getting contaminated related to COVID-19 was also seen high. There is a need to assess psychological issues and provide social support to police officers during this pandemic situation.Keywords: COVID-19; police officer; stress; Nepal
Lymphocyte Levels in Predicting the Outcome of COVID-19 Patient: A Prognostic Study from Single Center in Indonesia
Authors: Amin Chris Alberto , Liana Phey , Ahmad Zen , Hidayat Rachmat , Sari Nurmalia Purnama , Afifah Astari Rahayu , Hilda Fadhilatul
Published: November 2024

Background: Several laboratory parameters have been linked to Corona Virus Disease 2019 (COVID-19), with lymphocytes being one of the most important. Lymphopenia is frequently linked to a worsening of clinical symptoms and an increased risk of death in COVID-19. This study aimed to determine the role of lymphocyte levels in predicting COVID-19 patient mortality. Methods: This is a prognostic study that is conducted from March 1 to August 31, 2020. Data from medical records and laboratory findings of COVID-19 patients were used in the study. Patient distribution and complete blood count were among the information gathered. ROC curve analysis, bivariate analysis (Chi-Square and Mann Whitney), in addition to survival analysis (Kaplan-Meier) were used to analyze the data. Results: In a total of 318 patients, 59 were non-survivors and 259 were survivors. Besides, a cut-off value of ?1460 cells/µL (P<0.05) was used for lymphocyte levels. Lymphopenia also has a 4.35-fold increase in the risk of mortality. Furthermore, the survival analysis revealed differences in the probability of survival within 30 days between COVID-19 patients with lymphopenia and those without (HR: 5.5722 (3.2509–9.5510), 95% CI; p<0.0001). A lymphocyte count of ?1460 cell/µL can increase the risk of death by fourfold.Conclusions: The findings of this study indicated a significant difference in outcome between lymphopenia and non-lymphopenia patients. Lymphopenia plays an important role in estimating COVID-19 patient mortality.Keywords: COVID-19; lymphopenia; mortality; prognosis; survival analysis
Laparoscopic Management of Dermoid Cyst of Ovary is a Safe Procedure
Authors: Joshi Arun Prasad , Chitrakar Neer Shobha , Thapa Bimal Kumar , Pariyar Jitendra , Shrestha Isha , Maharjan Rima , Maharjan Pabitra , Dahal Sudip Chandra
Published: November 2024

Background: Dermoid cyst, a common benign neoplasm of ovary in women, needs treatment because of the risk of torsion, rupture, and malignant change. Laparoscopic surgery nowadays is the preferred treatment modality, but the only issue is its safety in case of rupture and spillage of its contents with the risk of chemical peritonitis and malignant dissemination. Aim of the study was to find out the safety of laparoscopic surgery for dermoid cyst of ovary.Methods: It was a retrospective study done from January 2017 to December 2019. All the women with diagnosis of dermoid cyst of ovary managed laparoscopically either salpingoophorectomy or cystectomy were taken into study. Analysis of size of the cyst operated, the time taken, spillage rate, duration of hospital stay, and post-operative complications especially chemical peritonitis was done.Results: There were 61 women who had undergone laparoscopic surgery. Laparoscopic cystectomy was done in 68.9% (n=42), laparoscopic salpingoophorectomy in 29.5% (n=18). Mean age of the patient was 31.74±8.38 years. Mean size was 6.21±1.99 cm. Rupture and spillage were observed in 21.3% (n=13) that were > 5cm in diameter (X2= 3.62, p=0.05). Larger the size of the cyst, more the surgical time was noted (X2=6.26, p=0.04). Significant difference in mean operating time in case of cyst rupture and spillage (p=0.004) was observed. Mean hospital stay was 53.5±1.3 hours. No case of chemical peritonitis was observed with spillage. All cases had histopathology of mature cystic teratoma.Conclusions: Laparoscopic surgery is safe for dermoid cyst of ovary even with rupture and spillage of its contents.Keywords: Dermoid cyst; laparoscopy; spillage
Perinatal Outcome of Second Twin in Third Trimester of Pregnancy
Authors: Baral Pramisha , Dangal Ganesh , Baral Gehanath , Subedi Kirtipal
Published: November 2024

Background: With increasing trend of twin pregnancy and along with increasing advancement in neonatal care, survival rate of twin pregnancy has increased. However there is worse perinatal outcome in second twin in comparison with the first twin.Methods: Hospital based observational cross-sectional study of 42 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital was conducted from November 2019 to October 2020. The outcome of second twin was assessed in relation to gestational age, chorionicity, mode of delivery, delivery interval. McNemar test was used for analysis with 0.05 as the level of significance.Results: Among 42 pair of twins, Apgar score of the second twin was found to be lower than the first twin (p=0.00) in general and in preterm gestation (p=0.115). Among twin who had monochorionic placenta; higher number of twin 1 had Apgar score of ?7(p=0.004). Among twin who had inter-delivery interval of <30min; higher number of twin1 had Apgar score of ?7 at 5 minutes. (p=0.00).Conclusions: Second twin has lower Apgar score in relationship to period of gestation, mode of delivery, inter-delivery interval, and chorionicity.Keywords: Apgarscore; chorionicity; twin pregnancy
Pneumomediastinum in COVID-19 Patients with Acute Respiratory Distress Syndrome
Authors: Pokhrel Bidushi , Adhikari Gauri , Pangeni Raju , Regmi Pradeep Raj , Baniya Anish
Published: November 2024

Background: Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of COVID-Acute respiratory distress syndrome. It has been unclear whether this entity represents an indicator of poor clinical outcome or not. The aims of this study were to find out the incidence of pneumomediastinum in COVID-Acute respiratory distress syndrome patients, describe their clinical characteristics and try to explain its plausible mechanisms..Methods: A descriptive, cross-sectional study was carried out in the ICU of our hospital among 280 patients admitted with COVID-Acute respiratory distress syndrome over a period of 6 months. Demographics along with various clinical, laboratory, and radiological parameters were analyzed. Relevant statistical analyses were done to summarize our findings.Results: The incidence of pneumomediastinum in COVID-ARDS patients was 2.8%. All patients were male, none had pulmonary co-morbidities and six of them (60%) were on invasive mechanical ventilation. All intubated patients were on lung protective mechanical ventilation. The median PEEP, peak airway pressure and plateau pressure were 10 (IQR: 4), 29 (IQR: 8) and 28 (IQR: 4) respectively. The mean CT severity score was 22.7 (SD: 1.64). Five patients died after 6.8 days (SD: 4.8) of diagnosis. The average hospital stay was of 34 days.Conclusions: Pneumomediastinum is a possible complication of COVID-Acute respiratory distress syndrome which could signify the disease severity and vice versa. Furthermore, it could be an indicator of relatively poor prognosis and therefore requires larger studies to establish the association.Keywords: ARDS; COVID-19; macklin effect; Nepal; pneumomediastinum
Understanding the Situation and Effectiveness of Adolescent Focused Tobacco Control Policies in Nepal : A Qualitative Study
Authors: Shakya Sangita , Shrestha Inisa , Pradhan Pranil Man Singh
Published: November 2024

Background: Tobacco use is a major risk factor for non-communicable disease that contributes two third of deaths in Nepal. Tobacco related premature deaths are estimated to rise every year if effective interventions are not implemented. In Nepal majority of smokers start using tobacco in their adolescence. Despite the enforcement of tobacco control law in 2011, the use among adolescents remains high. Hence, this study was carried out to understand the situation and effectiveness of adolescent focused tobacco control policies.Methods: Data were collected by focus group discussions in seven provinces of Nepal. Total 28 focus group discussions were carried out with four in each province incorporating both genders. Adolescents between age of 13 and 18 years attending both public and private schools were selected. Data were analyzed manually using a thematic analysis method in MS Excel and Word.Results: Tobacco control law on prohibition of sale and distribution of tobacco products to minors and prohibition of sale within 100-meter radius of educational institutions were not implemented properly. Adolescents’ students were not stopped and inquired about their age and could easily access tobacco at shops nearby school area. Shopkeepers were not hesitant to sell tobacco to adolescents in school uniform, if they are purchasing for their parents or family members.Conclusions: The adolescent focused tobacco control laws have not been implemented effectively. The current provisions of tobacco control law needs stronger adherence and strict enforcement in order to protect the adolescents from the burgeoning epidemic of tobacco use. Keywords: Adolescent; prevention; tobacco; tobacco policy
Detection of Colonic Polyps During Colonoscopy in a Tertiary Care Center of Nepal
Authors: Koirala Dinesh , Pathak Rahul , Kafle Bhandari Brindeswari , Jha Anurag , Hamal Rabin , Gnawali Arun , Pandey Rajesh , Bhusal Mohan
Published: November 2024

Background: Colorectal cancer is the third leading cause of cancer death in the world. Most colon cancer develop from the polyps. Data on the prevalence of colorectal polyps in Nepal is lacking. The objective was to determine the prevalence of colorectal polyps, site of occurrence and adenomas among various age groups. All polyps after removal by polypectomy was sent for histopathological examination.Methods: Study was done in 1027 consecutive patients who underwent colonoscopy in the pre-specified time after excluding patients with colorectal cancer, Inflammatory Bowel Disease and polyposis syndromes. Results: Among 1027 patients, the mean age was 45 years. 292 (28.43%) were below 40 years, whereas, 735 (71.57%) were above 40 years. Polyps were detected in 12.95% of overall patients and in 9.73% of patients over age 40. The most common location of polyps was rectum (46.62%). 43.61% were adenomatous polyps, 11.28% were hyperplastic polyps, 18.05% were juvenile polyps, 22.56% were inflammatory polyps and 1.50% were malignant adenocarcinoma. Polyp detection rate was 12.95%, whereas adenoma detection rate was 5.84%. 46.55% had advanced adenomas. A positive correlation between the size of polyp and adenomatous variety was found [Chi-square value ?2 = 8.42 (>3.841), p value <0.05]. Prevalence of adenomatous polyps was significantly higher above the age of 40 [Chi-square value ?2 = 11.53 (>3.841), p value<0.05]. Conclusions: The prevalence of polyp increases with age. With increasing age and size of polyp, the prevalence of adenomatous polyp increases significantly. One out of every eight people over 40 years had a colonic polyp.Keywords: Colorectal cancer; colonoscopy; colonic polyp; screening
Antibiotics Self-Medication Practice Among Medical Students
Authors: Shrestha Deepti , Barakoti Achut , Shakya Gurung Rashmi , Paudel Rekha , Sapkota Jyotshna , Deo Satish
Published: November 2024

Background: Self-medication of antibiotics is common among healthcare students due to their knowledge of pharmacology of antibiotics, which produces a false sense of confidence in self-diagnosis of disease conditions. Hence, this study was conducted to assess the practice of self-medication with antibiotics among medical students.Methods: This questionnaire based descriptive, cross-sectional study was conducted in Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from September 2019 to February 2020 on the Bachelor of Medicine and Bachelor of Surgery students.Results: Out of 405 students, 214 (52.8%) students had practiced antibiotics self-medication. The most commonly self-medicated antibiotics were azithromycin 126(58.9%), amoxicillin 67(31.3%), metronidazole 35(16.4%) and ciprofloxacin 14(6.5%) that were most commonly used for sore throat 93(43.5%), fever 82(38.3%), common cold 59(27.6%) and cough 43(20.1%).The common sources for self-medication were previous prescription 66 (30.8%), followed by own pharmacological knowledge 58 (27.1%). The most common reasons for practicing antibiotics self-medication were stated as previous experience of same illness 165 (77.1%), doctor’s advice not deemed necessary 21 (9.8%) and save time 14 (6.6%). Large number of students agreed that antibiotics self-medication was not an acceptable practice 308(76.1%) and can lead to antimicrobial resistance 363(89.6%). Conclusions: More than half of the respondent medical students had practiced antibiotics self-medication. Sore throat was the commonest cause for it while the most commonly self-medicated antibiotic was azithromycin. Self-medication with antibiotics in medical students is concerning because they are future prescribers of antibiotics; who are supposed to promote rational use of antibiotics.Keywords: Antibiotics; antimicrobial resistance; awareness; medial students; self-medication
Risk Factors Associated with Diabetic Ketoacidosis at the Onset of Type 1 Diabetes Mellitus
Authors: Kansakar Prerana , Shrestha Shrijana , Paudyal Buddhi Prasad , Prajapati Alisha , Shrestha Narottam
Published: November 2024

Background: There are various factors which increase the risk of diabetic ketoacidosis at the onset of type 1 diabetes mellitus. There have not been any such studies in our setting. This study was done to find the prevalence and risk factors associated with the development of diabetic ketoacidosis at onset of type 1 diabetes mellitus. Methods: Children and young adults with type 1 diabetes mellitus being treated at Patan hospital were approached and after obtaining an informed consent, all the patient information on various risk factors for diabetic ketoacidosis were collected in a pre-developed proforma. Data was entered in Microsoft Excel and analysis was done using statistical package for the social sciences-16. Ethical approval was taken from Institutional Review Committee- Patan Academy of Health Sciences. Results: Out of 99 patients with type 1 diabetes enrolled in the study, 52.5% presented in diabetic ketoacidosis at the onset. The duration of symptoms was significantly less in patient presenting with diabetic ketoacidosis than without diabetic ketoacidosis (6.45±7.57 vs 9.13±10.12, p=0.04). There was no significant difference in the mean age, mean glycosylated hemoglobin, mean body mass index, gender, parents’ literacy and medical consultations prior to diagnosis. Conclusions: More than half of the patients with type 1 diabetes presented in diabetic ketoacidosis. The shorter duration of symptoms prior to presentation was the only significant factor leading to presentation as diabetic ketoacidosis.Keywords: Diabetic ketoacidosis; risk factors; type 1 diabetes mellitus.