bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Anxiety Assessment in Adult Patients Undergoing Elective Surgeries: A Cross-Sectional Observational Study
Authors: Acharya Santosh , Gurung Renu , Parajuli Basudev
Published: July 2024

Introduction: Anxiety is the subjective unpleasant feeling of dread over something unlikely to happen. The incidence of preoperative anxiety ranges from 32% to 76.7%. We aimed to measure the preoperative anxiety level using Amsterdam Preoperative Anxiety and Information Scale questionnaire and clinical rating scale given by attending anesthesiologist / anesthesia residents.
Methods: It was cross-sectional observational study conducted in wards. We enrolled 110 adult patients planned for elective gynecological and gastrointestinal surgeries. After taking informed written consent, principal investigator interviewed the patient, one day prior to surgery in wards using a structured questionnaire of Amsterdam Preoperative Anxiety and Information Scale. Demographics characters were recorded. The attending anesthesia residents (blinded to patient response) performed preanesthetic assessment, provided their subjective rating about patient anxiety and need for information using Clinical Rating Scale.
Results: Out of 110 patient, 57(51.81%) were found to have higher anxiety level. Comparing the APAIS score with various factors, we found younger age, female gender, unemployed status, higher level of education, adverse events in previous surgery and higher grade of surgery was associated with higher anxiety score. Comparing APAIS with Clinical Rating Score, there was poor correlation.
Conclusion: The incidence of preoperative anxiety is high (51.81%) in adult patients undergoing elective surgery. During the preoperative anesthetic checkup, APAIS can be used as a screening tool. It provides relevant information on the presence of preoperative anxiety and need for information, which helps to achieve patient satisfaction and better outcome.
Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal
Authors: Subedi Nirajan , Kandel Bishnu , Ghimire, Bikal , Kansakar Prasan BS , Bhandari Ramesh S , Lakhey Paleswan Joshi
Published: July 2024

Introduction: Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site.
Methods: This is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics.
Results: A total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%.
Conclusion: PPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.
Does Drilling Induce Hearing Loss after Modified Radical Mastoidectomy? A Retrospective Study
Authors: Neupane Yogesh , Kharel Bijaya , Dutta Heempali
Published: July 2024

Introduction: Incidence of sensory neural hearing loss following mastoid surgery varies from 1.2 – 4.5%. There are various causes for postoperative sensorineural hearing loss during mastoid surgery. This study aims to identify whether there is any correlation between drilling and postoperative sensory neural hearing loss.
Methods: A retrospective study was conducted in the Department of ENT from January 2018 to June 2019. A total number of 68 patients above five years of age who underwent modified radical mastoidectomy for chronic otitis media squamous were included. Revision surgery, preoperative sensorineural hearing loss, injury to the ossicular chain during surgery, patients with lack of follow up or doubtful reports in mentally challenged were excluded from the study. The average bone conduction threshold was calculated from 500, 1000, 2000, 4000 Hz and compared using the Wilcoxon signed-rank test.
Results: There were 43 males and 25 females in the study with a median age of 23.5 years (16-55). The mean preoperative bone conduction threshold in the four frequencies of 500 Hz, 1kHz, 2kHz, 4kHz were -2.06dB, -2.06dB, 3.31dB, 4.63 dB respectively and the mean postoperative bone conduction thresholds were 1.03, 1.32, 5.29, 4.04 respectively. There was a decline of mean of 3.09 dB and 3.38dB only at the low-frequencies (500Hz and 1kHz) BC threshold respectively which were statistically significant, whereas at higher frequency there was no decline in average postoperative BC threshold.
Conclusion: There is no definite role of drill in inducing hearing loss and if present other causes of hearing loss should be sought in postoperative sensorineural hearing loss.
Admission Profile and Outcome of Patients in a Level III Intensive Care Unit: A Two-Year Comparative Study
Authors: Pathak Sunil , Acharya Subhash P , Acharya Pragya , Bhattarai Binita
Published: July 2024

Introduction: An Intensive Care Unit (ICU) is an area where critically ill patients are admitted and the highest level of care is provided with close intensive monitoring and management. Clinical audit is a must to measure indicators of the quality of care in ICU and benchmarking outcome. The main aim of the study was to evaluate the profile of patients admitted to ICU and assess their outcome of two consecutive years.
Methods: A single-institutional, descriptive cross-sectional study was conducted on all adult patients admitted to the ICU of Tribhuvan University Teaching Hospital, Kathmandu, between April 2018 and April 2020 (Baisakh 2075 to Chaitra 2076).
Results
: With an average of 1.98 admissions per day, a total of 1447 patients were admitted to TUTH ICU over the period of two years. A male preponderance was noted with a male to female ratio of 1.19:1. Most of the patients admitted were neurosurgical cases 429 (29.6%). A total of 884 (61%) were shifted out of ICU in stable condition while the overall mortality was 458 (31.6%).
Conclusion: This study shows that there is a higher severity of illness at admission as well as a comparatively high mortality rate. More number of patients were male, of age group of 15-65 years, with medical and neurosurgical conditions. This study of profile and outcome of patients admitted in ICU can serve as a quality indicator as well as evidence on which planning and policymaking can be based upon in the future.
Correlation of Body Mass Index with Handgrip Strength and Endurance of Dominant Hand in Medical Students
Authors: Shrestha Lava , Gurung Sanyukta , Bhat Neeti , Mahotra Narayan B , Bajimaya Mahesh M , Malla Neha , Kandel Sabita , Shakya Aman , Aryal Vibina , Gyawal Bigyan R , Rayamajhi Nirmala , Pradhan Sait
Published: July 2024

Introduction: Hand grip strength is used in evaluation of muscle strength and is also increasingly being used as an indicator for nutritional status. The maximum force applied voluntarily by the subject is called maximum handgrip strength, which is measured in kilograms. Muscular endurance is the ability of a muscle or muscle group to perform against a load for an extended period of time, measured in seconds. This study aims to correlate body mass index with handgrip strength and handgrip endurance in medical students.
Methods: This is a cross sectional, observational study which included 74 undergraduate students of Maharajgunj Medical Campus by convenient sampling method. Body mass index was calculated by Quetelet’s formula. Camry digital hand dynamometer was used to measure handgrip strength in the dominant hand in kilograms. Participants were instructed to hold dynamometer with maintained pressure of 30% of maximum handgrip strength for as long as possible to determine the handgrip endurance. Statistical analyses were performed with SPSS Statistics software.
Results: The handgrip strength was more in males than females with a mean of 43.09±3.72 kg, while handgrip endurance was more in females with a mean of 123.60±50.65 sec. Positive correlation was seen between body mass index and handgrip strength (r=0.23 and p=0.045). Body mass index and handgrip endurance also showed positive correlation (r=0.34 and p=0.003).
Conclusion: Significant correlation of body mass index with handgrip strength and handgrip endurance was seen in medical students.
Post-Transplant Erythrocytosis in Live Donor Kidney Transplant Recipients: A Retrospective Single Center Study
Authors: Maharjan Suresh , Chhetri Santosh , Khatri Bikash , Sapkota Nisha , Sigdel Mahesh R
Published: July 2024

Introduction: Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin>17 g/dl and/or PCV>51% in kidney transplant recipients. The incidence of PTE varies from 5% to 17%, with occasional life-threatening thromboembolic complications. We aimed to study the prevalence, risk factors and complications of PTE.
Methods: We conducted a retrospective single center study in 132 kidney transplant recipients who had undergone live donor kidney transplantation at Tribhuvan University Teaching Hospital, Nepal, between October 2017 and March 2019. Prior approval was obtained from Institutional Review Committee of Institute of Medicine. Patients with hemoglobin>17 g/dl were defined as PTE group, and others as non-PTE group. The pattern of hemoglobin, serum creatinine, pre-transplant hemoglobin, native kidney disease, immunosuppression medications, rejection episodes, and new onset diabetes after transplantation were analyzed and compared between two groups.
Results: Out of the 132 kidney transplant recipients, PTE was diagnosed in 28 (21.2%) patients, out of which 27 patients (96.4%) were male and 1 (3.6%) were female with the mean time of onset at 7 months after transplantation. Patients with erythrocytosis had a relatively shorter duration of pre transplant dialysis (p=0.001). The mean pre transplant Hb and Hct in PTE group was 9.72g/dl and 30.35% whereas in non PTE group 10.02 g/dl and 31.31%. Thromboembolic and any other PTE related complications were not observed. Seventeen patients of PTE (60.7%) were treated with ACE Inhibitors and 11 (39.9%) patients did not require any treatment.
Conclusion: Post-transplant erythrocytosis was seen in nearly one fifth kidney transplant recipients at mean time of seven months post-transplantation; was more common in male with good graft function, and short duration of pre transplant dialysis. Response to ACE inhibitors was good.
Prevalence of Stunting among 6-59 Months Children and its Association with Water, Sanitation and Hygiene Practice in Urban Slums of Kathmandu, Nepal
Authors: Singh Sarswoti , Dhital Nil P , Paudel Rajan , Sah Dipak K , Hamal Arjun , Shrestha Junu
Published: July 2024

Introduction: Childhood malnutrition is a critical public health concern in Nepal. Slums are supposed to have poor water, sanitation and hygiene practices. This study has aimed to examine association between water, sanitation and hygiene (WASH) variables and stunting among 6 to 59 months children of slums of Kathmandu metropolitan city.
Methods: Descriptive cross-sectional study design was employed where 335 households were included in the study. Data were collected using standard questionnaire and observation checklist. Weight and height of children were taken using seca digital weighing scale and wooden height board of UNICEF respectively. Anthropometric analysis was done using WHO Anthro version 3.2.2 software and other statistical analysis was conducted using SPSSversion 22 software.
Results: The prevalence of stunting was 23%. Four out of five household (80%) in slum used to drink water from unimproved source. Absence of handwashing station (AOR=2.109, 95% CI:1.05-3.27) and absence of water storage covering (AOR=2.46, 95% CI: 1.16–5.23) were found to be significantly contributing to stunting status.
Conclusion: This study highlights the importance of good WASH practices, and the potential of WASH interventions, to contribute for the improved childhood stunting living in urban slums in Nepal. Also, the findings recommend the need of strategies on purification of water, improvement of toilets, behaviour change and awareness related activities to improve the stunting among children.
Relation of Neck Circumference to Central Obesity and Overweight in Patients with Type 2 Diabetes Mellitus Presenting to a Tertiary Center
Authors: Sharma Ishwor , Gupta Sanjay K , Niraula Kiran
Published: July 2024

Introduction: Overweight and obesity with their surrogate anthropometric markers like body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) have been shown to be strongly associated with Type 2 diabetes mellitus. Neck circumference (NC) though less used can be an equally effective alternative to diagnose overweight and obesity in patients with Type 2 diabetes mellitus in a resource limited setting.
Methods: Patients who had Type 2 Diabetes Mellitus for 5 years or more and above 35 years underwent simple random sampling. Weight, height, WC and NC were measured. BMI was calculated and patients were graded into overweight and obesity based on the Asian cutoffs for BMI and abdominal obesity.
Results: Among 100 patients enrolled in this study, 45% were men and the mean age was 53.05. Mean neck circumference was 36.55 ± 1.28 cm and 35.27 ± 1.78 cm for male and female respectively. NC was positively correlated with WC and BMI in both men and women (p ˂ 0.001). In the ROC curves, NC presented the largest area under the curve (AUC) for overweight in males (p ˂ 0.001), while NC presented a large AUC for central obesity in both genders. Furthermore, the cut off value of neck circumference for overweight was 35.6 cm in males vs 35.2 cm in females and for central obesity was 36.75 cm in males vs 34.75 cm in females.
Conclusion: Neck circumference was positively associated with overweight and central obesity in patients with type 2 diabetes mellitus.
Plasma Fibrinogen Level in Chronic Obstructive Pulmonary Disease and Its Correlation with GOLD Severity Staging
Authors: Gyawali Achyut , Bam Niraj , Pant Pankaj , Das Santa K
Published: July 2024

Introduction: Chronic obstructive pulmonary disease (COPD) has great implications on global health accounting for significant morbidity and mortality. It is a state of chronic inflammation of airways. The aim of this study was to measure the plasma fibrinogen level in patient with COPD and find the relationship between plasma fibrinogen levels and severity of airflow obstruction.
Methods: This observational study was conducted from September 2017 to October 2018, where 80 eligible patients with the diagnosis of acute exacerbation of COPD (AECOPD) were included in the study and their plasma fibrinogen level was measured at the time of discharge. Clinical information was obtained and pulmonary function test (PFT) was done.
Results: A total of 80 patients were enrolled. The mean age of the patient was 67.87±11.60 years. Plasma fibrinogen level was 159±12.72 mg/dl in mild COPD, 273.52±62.34 mg/dl in moderate COPD, 312.30±103.67 mg/dl in severe COPD, and 487±102.76 mg/dl in very severe COPD. The comparison between groups showed significant difference in plasma fibrinogen level (p<0.001). There was significant negative correlation between plasma fibrinogen level and forced expiratory volume in one second (FEV1%) predicted (r=-0.71, p=0.01).
Conclusion: High plasma fibrinogen level on discharge was found in COPD patients with severe airflow obstruction, frequent exacerbations and severe level of dyspnoea during AECOPD.
Correlation of Status of Mastoid with Outcomes of Myringoplasty with Cortical Mastoidectomy in Mucosal Otitis Media with High Risk Perforation
Authors: Shrestha Asmita , Bhattarai Hari , Rayamajhi Pabina , Pradhananga Rabindra B
Published: July 2024

Introduction: Chronic mucosal otitis media is one of the common disease prevalent in our society. This study was done to correlate the status of mastoid with outcomes of myringoplasty with cortical mastoidectomy in mucosal otitis media with high risk perforation.
Methods: This prospective, observational study was done at Department of Otorhinolaryngology and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Thirty-four patients of ag|e 15 and above with chronic mucosal otitis media having high-risk perforation undergoing cortical mastoidectomy with myringoplasty were included. The status of middle ear, aditus, and mastoid air cells were assessed. Post-operatively, patients were assessed for graft uptake and hearing after three months. The post-operative graft uptake and hearing results were correlated with the peroperative status. Four patients who had preoperative sensorineural hearing loss were studied in terms of graft uptake only.
Results: The graft success rate in patients with normal mastoid air cells was 90% whereas in diseased cases was 71.4% which was statistically not significant with p value 0.20. The success rate in terms of hearing was 68.8% in normal mastoid whereas it was 64.3% in diseased mastoid which was statistically not significant with p-value of 1.
Conclusion: In correlation with the status of mastoid air cells with graft uptake and hearing result, the observed differences were not statistically significant. However, averages of post-operative air conduction threshold and air-bone gap of all cases were better as compared to preoperative levels.
Diurnal Variability of Peak Expiratory Flow Rate in Healthy Adult Employees of a Medical College of Kathmandu
Authors: Khakurel Gita , Gautam Kalyan , Chalise Sanat
Published: July 2024

Introduction: Peak expiratory flow measurement is a simple measure of respiratory capacity to diagnose airflow obstruction and monitor treatment response in patients with pulmonary diseases. But there is wide diurnal variability in its values. The objectives of this study was to determine the diurnal variability of peak expiratory flow rate in healthy adults.
Methods: This cross-sectional study was done in employees of Kathmandu Medical College, Duwakot between March to August 2020. A total of 74 subjects of 30-45 years were included in the study. After adequate training, subjects were asked to record their own peak expiratory flow five times a day by Mini-Wright peak flow meter. Diurnal variability was expressed as amplitude percent mean and standard deviation percent mean. Data analysis was done by student’s unpaired t-test and one-way ANOVA.
Results: The mean peak expiratory flow rate (in L/min) were lowest in morning (male: 478.75±45.91; female: 362.86±20.51) followed by progressive rise throughout the day and highest at evening (male: 531.88 ±43.95; female: 415.71±20.97) with slight fall at bedtime (male: 486.88±46.38; female: 362.86±20.51). The difference in peak expiratory flow rate at different time periods was statistically significant in both males and females (p<0.001). The diurnal variability as calculated by amplitude percent mean and standard deviation percent mean were found to be significantly higher in females (p=0.001 and 0.004 respectively).
Conclusion: There is a variation of peak expiratory flow rate recorded during different time points of the day in healthy adults.
Management of Choledochal Cyst: Experience from A Tertiary Care Center of Nepal
Authors: Shrestha Sujan , Ghimire Bikal , Kansakar Prasan , Bhandari Ramesh S , Joshi Lakhey Paleshwan
Published: July 2024

Introduction: Choledochal cysts are infrequent congenital cystic dilation of the biliary tract. The aim of this study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts.
Methods: This is a retrospective study of 32 consecutive patients of choledochal cyst who underwent multidisciplinary management in last two and half years at Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Results: A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5(15.63%). Triad of pain, jaundice and mass was present in 4(12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (MRCP) (68.75%), and contrast enhanced computed tomography (CECT) (31.25%). Endoscopic retrograde cholangiopancreatography (ERCP) was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). The overall morbidity was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination.
Conclusion: Choledochal cyst was common in young females. Type IC and IVA choledochal cyst were the most common types and majority of them were symptomatic. Cyst excision with Roux-en-Y hepaticojejunostomy was the commonest surgical treatment modality and had excellent perioperative outcome.
Emergency Transport, Diagnosis and Resuscitation of Penetrating Injury Caused by Iron Rod: A Case Report
Authors: Shrestha Jukel , Bastola Hemanta , Koirala Dinesh P , Shakya Jasmine , Bom Rabin , Maharjan Ramesh K , Shakya Yogendra M , Prasad Pratap N
Published: July 2024

Foreign bodies with their long edges that penetrate the body are potentially life-threatening, owing to the resulting hemorrhagic shock and visceral damage. In an under-resourced environment, the outcome after major impalement injury can be improved by (a) rapid transport with the impaled object in situ (b) quick assessment and resuscitation in the emergency room (c) transport to operating room for definitive care. We report here the successful management of penetrating long iron rod injury from the perineum to the loin of pediatric patient, including transport from rural to tertiary hospital, diagnosis and, resuscitation.
Low Estimated GFR Predicts Hemorrhagic Complication in Acute Ischemic Stroke: A Meta-analysis
Authors: Nepali Gaurav , Shrestha Gentle S , Yadav Jayant K , Pathak Santosh , Ojha Rajeev
Published: July 2024

Introduction: Intracerebral hemorrhage (ICH) can occur in patients following acute ischemic stroke (AIS) and results in significant long-term morbidity and mortality. Patients with renal impairment have a higher risk of bleeding. Therefore, AIS patients with renal impairment may have a higher risk of such complications. We performed a meta-analysis of observational studies to determine the relationship between renal impairment and hemorrhagic complications in patients with AIS.
Methods: This meta-analysis was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. PubMed, Google Scholar, Web of Science and China National Knowledge Infrastructure (CNKI) were searched to identify studies published between 1995 and 2020. Relative risk estimates of all the included studies were pooled to calculate pooled OR and 95% confidence intervals.
Results: Fourteen studies involving 10,033 AIS patients from Asia, Europe, and North America were included. We found that patients with renal impairment as indicated by low eGFR had a higher odds of developing any ICH (OR: 1.7; 95% CI: 1.13 to 2.57; p=0.011; I2=87.2%) following AIS. Similarly, we found that patients with renal impairment had a higher odds of developing symptomatic ICH (SICH) (OR: 1.7; 95% CI: 1.32 to 2.17; p<0.001; I2=37.3%) following AIS.
Conclusion: There is an increased odds of developing any ICH and SICH in AIS patients with renal impairment.
Researcher’s Personal Profile on Academic Social Network Sites: Connection, Visibility, and Impact of Academic Work
Authors: Shah Jay
Published: July 2024

A researcher's personal profile helps communicate and increase the visibility for academic work. Online personal profiles greatly enhance sharing of information and interaction with the academic community. This interaction and visibility further benefit in career advancement, funding, citation score, and many more. Academic Social Network Sites provide facilities for the creation of a personal profile that links the research and publications which can be verified easily and helps generate author-level metrics, unlike the traditional biodata.
Histopathological Findings of Pancreaticoduodenectomy Specimens in a Tertiary Care Hospital in Nepal
Authors: Karki Shovana , Shrestha Sonafi , Tiwari Sansar B , Lakhey Paleswan Joshi
Published: July 2024

Introduction: Among the gastrointestinal malignancies, 5% of the tumors comprise peri-ampullary carcinomas. Adenocarcinoma is the commonest malignancy in the peri-ampullary region. The important histopathological prognostic factors are tumor size, location, extension, resected marginal status, lymphovascular (LVI) and perineural invasion (PNI) and lymph nodal status. This study was conducted to analyze the lesions and to describe the associated histopathological parameters.
Methods: This study was carried out in the Department of Pathology, TUTH, Kathmandu, includes pancreatico-duodenectomy specimens submitted from April 2016 to September 2020. The related details were obtained from the archives of reports in the Department. Statistical analysis was performed using IBM SPSS v26.
Results: Among 111 specimens, 100 (90%) malignant lesions, 10 (9.1%) benign lesions and 1(0.9%) pre-malignant lesions were seen. M:F ratio was 1.2:1 with mean age 55.5 years. Ampulla was the most common site of malignancy (61%) and adenocarcinoma was the commonest histological type. Chronic pancreatitis (4.5%) accounted for most of the benign lesions. Ampullary and pancreatic malignancies were detected in T2 stage, 55.7% and 77.8% respectively. LVI was seen in 61% and PNI in 72% of pancreatic malignancies. Positive resected margin was seen in 6% of malignancies. SMA was the most common positive margin.
Conclusion: Pancreatico-duodenectomy was performed mostly for adenocarcinomas of ampulla. Pancreatic tumors were common in the older age group and they presented with LVI and PNI and at a higher T and N status as compared to ampullary or duodenal tumors.
Single Dose Versus Multiple Dose Prophylactic Antibiotics in Cesarean Section in a Tertiary Care Hospital
Authors: Rajbhandari Subrina , Acharya Sarita , Subedi Nilam , Gurung Gahana , Das Ruby , Bajracharya Sunita
Published: July 2024

Introduction: Choice of antibiotics as prophylaxis has become crucial factor for morbidity of women after delivery and neonatal complication associated thereafter. The purpose of this study was to compare the efficacy of single dose versus multiple dose of ceftriaxone in cesarean section (CS).
Methods: A prospective experimental study was carried out in Universal College of Medical Sciences and Teaching Hospital, Tribhuvan University, Bhairahawa, from May 2015 to October 2016. One hundred patients who had undergone cesarean section were divided in two groups with fifty in each. Patients in group I were treated with single dose of ceftriaxone, whereas patients in group II were treated with multiple dose of ceftriaxone. The data were analyzed using independent "t" test, chi-square test as appropriate. A p-value of <0.05 was considered significant.
Results: The distribution of Emergency CS and Elective CS were 72% and 28% in prophylactic single dose group and 88% and 12% in postoperative multiple dose regime and was statistically non-significant difference between single and multiple dose ceftriaxone. One wound infection was observed in multiple dose ceftriaxone treated women as compared to single dose ceftriaxone treated women. Febrile morbidity (8%) and urinary tract infections (2%) were observed in postoperative multiple dose regimen as compared to prophylactic single dose regimen.
Conclusion: Prophylactic single dose of ceftriaxone was effective in reducing infective morbidity in patients with cost benefit, and also reduces chances of drug resistant in future.
Fasting Serum Magnesium Level and its Association with Type 2 Diabetes Mellitus and its Chronic Complications
Authors: Lamsal Manoj , Thapaliya Sabin , Thapa Pradeep , Bhandari Roshan , Sangroula Raj K , Sayami Matina , Shrestha Pradeep K
Published: July 2024

Introduction: Diabetes mellitus is one of the most common metabolic disorders. Hypomagnesemia is a common feature in patients with type 2 diabetes mellitus (T2DM). This study aims to assess the serum magnesium level and its association with chronic complications in patients with T2DM.
Methods: A total of 173 T2DM patients at Tribhuvan University Teaching Hospital were evaluated from July 2016 to August 2017. Patients were investigated for fasting serum magnesium level, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), Glycosylated haemoglobin (HbA1c) and also target organ evaluation for diabetes. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 20.
Results: Hypomagnesemia was found in 86 patients out of the 173 enrolled patients. Observations revealed significant association between hypomagnesemia and various microvascular complications viz. retinopathy (p=0.001), neuropathy (p<0.001) and nephropathy (p<0.001). There was also a significant association between hypomagnesemia and FPG (p=0.008) and HbA1c (p=0.009). The overall prevalence of hypomagnesemia among T2DM patients was 49.7% and the prevalence of hypomagnesemia was significantly higher (74%) among diabetic patients with microvascular complications (p=0.001) compared to diabetics with no microvascular complications.
Conclusion: There was a high prevalence of hypomagnesemia among T2DM patients. A significant association was seen between hypomagnesemia and various microvascular complications like retinopathy, neuropathy and nephropathy. Routine surveillance and timely treatment of hypomagnesemia is advisable for patients with T2DM.
Papillary Carcinoma of Thyroid in a Child, Rare but Aggressive: A Case Report
Authors: Regmi Pradeep R , Amatya Isha , Paudel Sharma , Kayastha Prakash
Published: July 2024

Thyroid nodules are uncommon in childhood than adult population. Thyroid malignancies are more common in the detected nodules comprising 22-26% in paediatric age groups in comparison to 5-15% of the adult population. In addition, thyroid malignancies are more aggressive in children than in adults with nodal and pulmonary metastasis. Despite having more recurrent rate than in the adults, survival seems to be better. We are presenting a case of an 11-year-old child presented to our clinic with swelling of neck for 3 months duration. Diagnosis was made through ultrasound, computed tomography and histopathological analysis. Therefore, diagnosing a case with papillary carcinoma of thyroid in children is very challenging and demanding the expertise. Paediatric radiologist could play a vital role in diagnosis which leads to proper management.
Comparison of Ultrasonography with Cole’s Formula to Determine Appropriate Endotracheal Tube Size in Pediatric Population
Authors: Shaheed Asadh M , Shrestha Bibhush , Pradhan Bishwas , Shrestha Anil , Parajuli Bashu D
Published: July 2024

Introduction: Recently, ultrasonography (USG) has gained popularity in perioperative airway management . One of the commonest method to select endotracheal tube in pediatric patients is Cole’s formula. Our study was conducted to assess if there was a measurable difference in the appropriateness of the endotracheal tubes as selected by the two methods.
Methods: The study group included 68 children scheduled for elective surgeries under general anesthesia with endotracheal intubation in an randomized prospective manner. The size of endotracheal tube was calculated using Cole’s formula in group A. In group B, ultrasound was done to measure the subglottic transverse diameter at the level of cricoid to find the largest outer diameter of tube .
Results: Ultrasonography group measuring the subglottic diameter was found to have more appropriately sized tubes than age-based Cole's formula (76.5% Vs 58.8% p=0.007). The pressure equilibrated measured (13.2 ± 5.2 cm of H2O in age based group and 17 ± 4.5 cm of H2O in ultrasonography group) was statistically significant (p=0.002). Also the incidence of selecting an inappropriately small sized ET tube was lower in the ultrasound group (5.9% Vs 35.3%). There were no significant differences in the number of intubation attempts and mean time required for intubation between the two groups.
Conclusion: Ultrasonographic method is a suitable alternative tool in predicting the size of uncuffed endotracheal tube in pediatric population than age-based Cole’s formula.
Trend of Antihypertensive Use and Blood Pressure Control Among Hypertensive Patients in a Tertiary Care Hospital of Kathmandu
Authors: Shrestha Deepti , Shrestha Shirish L , Poudel Rekha , Gurung Rashmi Shakya , Yadav Radhay Shyam , Shrestha Lava
Published: July 2024

Introduction: Hypertension is a global burden and prevalence of hypertension increases with age. Various antihypertensive drugs are available for the management of hypertension. The aim of this study is to assess the trend of antihypertensive drugs used and blood pressure (BP) control among patients with hypertension.
Methods: A cross sectional study was conducted among patients with hypertension prescribed with antihypertensive drugs in Department of Medicine, Nepal Medical College Teaching Hospital. Antihypertensive drugs, number of antihypertensive drugs prescribed in each individual and BP were analyzed.
Results: Out of 218 patients, 61.5% were female and 38.5% were male. Common age group range from 51-60 years in 28.4% of patients. Diabetes mellitus (23.4%) was the most common comorbid condition. Dual therapy (47.6%) followed by monotherapy (45.9%) was the most common therapy prescribed for patients with hypertension. Most commonly prescribed antihypertensive as monotherapy was Calcium Channel Blockers (CCBs), 29.4% and in dual therapy, CCBs and Angiotensin Receptor Blockers (ARBs), 38.6% were the most commonly prescribed medications. Fixed dose combination of antihypertensive drugs were prescribed in 81.4% patients receiving multiple therapy. Good BP control was observed in 61.2% of patients with hypertension.
Conclusion: Dual therapy followed by monotherapy was the most common therapy prescribed for the management of hypertension. Calcium channel blockers as monotherapy and CCBs and ARBs as combination therapy were the most common antihypertensive drugs prescribed for hypertension. More than half the patients had controlled BP. A therapeutic audit with more parameters of analysis to provide regular feedback to researchers and prescribers may encourage rational prescribing in hypertension.
Perioperative Modification in Cirrhotic Patient Undergoing Pancreatoduodenectomy: A Case Report
Authors: Regmee Sujan , Limnu Yugal , Ghimire Roshan , Maharjan Dhiresh K , Shrestha Suman K , Thapa Prabin B
Published: July 2024

Hepatic cirrhosis can be present in associated with patients undergoing pancreatoduodenectomy (PD). Many peri-operative measures need to be considered on such patients. A 83 years old gentleman presented with pain abdomen, Ultrasonographic evidence of dilated extrahepatic biliary system and distended gall bladder and contrast enhanced computed tomography (CECT) scan of the abdomen with features of a pancreatic head mass, further confirmed to be adenocarcinoma by endoscopic ultrasound (EUS) and biopsy. These findings were present on the background of Non-Alcoholic Steato-Hepatitis (NASH) associated liver cirrhosis, with Child–Turcotte–Pugh (CTP) score of 5 (CTP A) and Model For End-Stage Liver Disease- sodium (MELDNa) score of 13. The patient underwent PD. Histopathological evaluation showed a p T3 N2 moderately differentiated adenocarcinoma of the pancreatic head with Ishak scoring of liver biopsy 6. The postoperative course of the patient was uneventful and was discharged from the hospital on the 5th post-operative day. No readmission or re-operation was required.
Factors Affecting Readmission in Hospitalized Patients with Chronic Kidney Disease: a Single Center Study
Authors: Wagle Abhishesh , Sigdel Mahesh R
Published: July 2024

Introduction: Chronic Kidney disease (CKD) in itself and the associated comorbidities together put the patients at increased risk of hospitalization. We aimed to study the factors associated with hospital readmission within 30 days of discharge in hospitalized patients with CKD.
Methods: This was a single center descriptive observational study conducted in Tribhuvan University Teaching Hospital (TUTH), Kathmandu. Hospitalized CKD patients were evaluated for sociodemographic parameters, clinical profile and laboratory parameters; they were asked over the phone after 30 days of discharge if they had repeat hospitalization. Readmission rates were calculated and factors at admission associated with repeat hospitalization were analyzed.
Results: Out of 337 CKD patients 307 could be contacted. Fifty patients (16.28%) needed readmission. Readmission rate was higher in patients older than 75 years and between ages 25 to 50. Patients who were undergoing dialysis at TUTH (OR 3.324 CI 1.239-8.917, p=0.017), who belonged to Newari community (OR 2.85 CI 1.17-6.9, p=0.020) and those from Kathmandu valley (1.94,CI 0.94-3.99) had higher odds of readmission. Hypertension, diabetes mellitus and tuberculosis as a comorbidity had increased odds of readmission of (1.51,CI 0.60-3.77), (1.48, CI 0.79-2.76), (1.569,CI 0.441-4.468) respectively. Hemoglobin less than 9 gm/dl and serum albumin less than 35 gm/l had higher odds of readmission of (1.109 95% CI 0.605-2.033) and (1.877,95%CI 0.869-4.054) respectively.
Conclusion: Overall 30 day readmission rate of Hospitalized CKD patients was 16.28%. Elderlies, those with medical comorbiditites, anemic and hypoalbuminemic patients tended to have increased odds of readmission.
Factors Associated with Low Back Pain among Nurses at Tertiary Level Hospital in Kathmandu
Authors: Thapaliya Subekshya , Mishra Ravi K , Subedi Krishna K
Published: July 2024

Introduction: Nursing is a profession with high incidence and prevalence of low back pain with its medical and professional consequences. Personal and work-related factors are regarded as causal factors for back pain. The aim of study was to find out the Prevalence and contributing factors of low back pain among nurses working at a Tertiary level Hospital in Kathmandu.
Methods: A cross-sectional study was conducted among 290 nurses from different units/wards at Tribhuvan University Teaching Hospital. A self-administered, modified Nordic questionnaire and Keele Start Back Screening were used to collect data regarding prevalence of low back pain, its risk status and contributing factors. Descriptive statistics, inferential and univariate and multivariate logistic regression techniques were used for analysis.
Results: The findings of this study broadly confirm the high levels of back pain in nursing, with a one-year prevalence of low back pain of 84.1% for low back pain of at least one day and 21.92% among them were at high risk status. More than half (63.11%) of nurses reported from being prevented of carrying out normal activities. There was a significant association between low back pain and Age; 51-60 yrs (p= 0.04), body mass index; over weight (p = 0.03) and place of work; critical care unit (p = 0.02).
Conclusion: The prevalence of low back pain among nurses was high and should be actively addressed.
Lower Urinary Tract Symptoms, Serum PSA, Digital Rectal Examination and Prostate Volume in Patients Presenting to Urology Department: A Cross-Sectional Study
Authors: Raya Akash , Bhatta Pahupati , Sah Sanjay , Aryal Vibina
Published: July 2024

Introduction: Lower urinary tract symptoms (LUTS) are common presentation in the urology department in males after 50 years. Enlarged prostate can be evaluated by digital rectal examination (DRE) and ultrasound. Serum prostate-specific antigen (PSA) has been suggested as a reliable tool to estimate prostate volume (PV) and to predict the diagnosis of prostate cancer. The aim of this study is to correlate prostate-specific antigen with clinical data like age and international prostate severity score (IPSS), DRE finding and PV among subjects with LUTS.
Methods: Total of 175 cases were included in the cross-sectional study who presented with LUTS in the Urology Department. DRE was done and noted. Then the cases were advised for ultrasonography (USG) and serum PSA level was sent for investigation. According to the history given by the cases IPSS was done using the IPSS scoring questions. The result was obtained by grouping the cases according to the level of serum PSA
Results: The mean age of the total 191 cases was 72.23±10.46 years and mean PSA level in our study population was 9.08±23.69 ng/ml. Grade III PV was seen among 47.1% of the study population. IPSS scoring between 8-19 was seen among 68.1% study population. Correlation between serum PSA and age group (p=0.007) was significant. High significance (p<0.001) was seen in correlation between serum PSA and DRE finding, IPSS and PV.
Conclusion: Our study showed that serum PSA level plays an important role in the evaluation of prostate enlargement. The level of serum PSA along with presenting symptoms and clinical findings can help us to plan our mode of treatment accordingly.
Treatment of COVID-19 Patients during Second Wave in a Tertiary Care Center of Nepal
Authors: Devkota Pragya , Bajracharya Omi , Manandhar Tejendra , Kafle Sajala , Jha Nisha , Kafle Kumud K , Sijapati Milesh J
Published: July 2024

Introduction: The second wave of the COVID-19 pandemic was confirmed in Nepal in April 2021. It was caused by genetic variants of SARS-CoV2. The objective of the study was to find out severity of patients, their treatment and approximate drug cost for the treatment of COVID-19 in the second wave.
Methods: In this retrospective, cross-sectional study, data of all patients who tested positive and were admitted in KIST Medical College and Teaching Hospital between April 2021 – July 2021 was collected for the study. A total of 215 patients were included.
Results: Among the cases admitted, 190 (88.4%) patients were symptomatic. ICU/HDU admission was done in 113 (52.5%) cases, among which 33 (29.2%) patients received ventilator support. The patients treated in isolation unit were 102 (47.4%). Among the patients admitted, 23 (10.7%) were vaccinated. Severe cases were 80 (37%), moderate cases were 71 (33%) and mild cases were 49 (23%). Antibiotics were used in 190 (88.4%) cases. More than one antibiotics were used in 141 (65.6%) cases. Antifungals were used in 39 (18.1%) cases. Other drugs like corticosteroids were used in 185 (86%), proton- pump inhibitors in 179 (84.3%), antihistaminics in 169 (78.4%) and anticoagulants in 165 (76.7%), Vitamin C in 153 (71.2%), Vitamin D in 152 (70.7%) and zinc in 140 (65.1%) cases. The number of patients discharged after recovery was 151 (70.2%) and 41 (19.5%) patients died. The average drug cost was NPR. 3,246 in mild, 27,645 in moderate and 76,420 in severe cases.
Conclusion: Majority of patients were treated in ICU/HDU. Most commonly used drugs were antibiotics, corticosteroids and anticoagulants. Mortality was high in the second wave.
Maternal Satisfaction towards Spinal Anesthesia for Cesarean Section
Authors: Thapa Chitra , Gauchan Sabin , Bimali Sneha , Bhusal Srijana
Published: July 2024

Introduction: Patient satisfaction has become an important parameter to assess an overall quality of health care. We conducted this study to evaluate the level of maternal satisfaction with our anesthetic technique and to identify factors that compromise maternal satisfaction.
Methods: A descriptive cross-sectional study was conducted in two hundred patients who underwent cesarean section under spinal anesthesia after receiving ethical approval from the Institutional Review Committee. Preset questionnaires were asked in a face-to-face interview within 6 to 24 hours of cesarean section. Descriptive statistics was used to show frequency distribution and percentage of variables.
Results: The overall satisfaction level was 99%, with the lowest satisfaction level reported for pain therapy (88.5%). Subscale-wise, 90.5% of the patients were satisfied with the preoperative assessment and evaluation, 95% of the patients were satisfied with the intraoperative care and attention they received from their anesthetist, 97% of the patients were satisfied with their relationship with the anesthetist. More than 97% of the patients were satisfied with the level of care they received from their anesthetist.
Conclusion: In general, the overall maternal satisfaction towards spinal anesthesia was high in our population. To further increase our patient satisfaction we need to extend our services to the postoperative period as well.
Experience in Oral Cancer Reconstruction in a Tertiary Care Center of Nepal
Authors: Pradhan Rohan , Rayamajhi Sangam , Sharma Samit , Rai Sushant , Rajbhandari Bikesh , Niraula Himalaya , Shrestha Jayan M , Lohani Ishwor
Published: July 2024

Introduction: Oral cancer is one of the most common malignancies in Nepal. Most patients have locally advanced disease during their initial presentation, necessitating substantial resection and leaving significant deformity. Functional and anatomical restoration of these defects is crucial. This study analyzed the clinical presentation of oral cancer, surgical management, and encountered complications in the Nepalese context.
Methods: This was a single-center retrospective study of oral cancer reconstruction performed at Tribhuvan University Teaching Hospital, Kathmandu over four years period (September 2018 - September 2022). Demographics, clinical presentation, comorbidities, treatment, and complications were recorded and analyzed.
Results: Out of the analysis of 36 cases of oral cancer, most of the patients were in the fifth decade of life with male to female ratio of 3:1. The most common primary site involved was buccal mucosa (38.88%). Twenty-two cases (61.11%) were in the locally advanced stage. Tobacco chewing was a common entity in personal habits. Surgery consisted of eighteen pedicled, sixteen free flaps, and five local flaps. Pectoralis major myocutaneous flap was the commonest flap performed (38.46%). The overall complication rate was 58.33%. Orocutaneous fistula was the commonest (22.22%). The partial flap loss occurred in 8.33% (15.1%) and the total flap loss occurred in three free flaps.
Conclusion: The difficulties experienced in OC reconstruction were high complication rates, multiple redo surgeries, and extended hospital stays. Despite these challenges, all of our patients were released from the hospital with stable wound coverage. Furthermore, the study will provide a platform for a better understanding of the oral cancer reconstruction scenario in the context of Nepal.
Health Journalism: A Unique Specialty in Nepal
Authors: Singh Yogendra P
Published: July 2024

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