bluuebunny/crossref_metadata_2025 huggingface dataset:
HEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION USING MACINTOSH, MILLER AND MCCOY BLADES
Authors: Deo Gopendra Prasad , Gautam Suresh , Shrestha Indra Narayan , Regmi Bharati Sharma , Shrestha Subin , Yadav Nabin Krishna
Published: May 2022

Background: Direct Laryngoscopy and endotracheal intubation are essential components of administration of general anaesthesia but trigger major stress response, in the form of in­creased catecholamines leading to tachycardia and hypertension. This study is designed to compare the haemodynamic stress response with the Macintosh, McCoy and Miller blades.

Methods: This prospective comparative study was conducted in 150 ASA grade I and II pa­tients, undergoing laparoscopic cholecystectomy under general anaesthesia from March 2017, were randomly divided into three groups using Macintosh, McCoy and Miller blade for endotracheal intubation respectively.

Results: The groups were also comparable in respect to gender, mean age, ASA grade, Cor­mack and Lehane grade, Laryngoscopic intubation time, baseline heart rate, heart rate before laryngoscopy, baseline mean arterial pressure and Mean Arterial Pressure before laryngos­copy. The mean heart rates at end of 1, 3 and 5 minute were 93.58±13.11, 88.28±11.57 and 83.64±10.94 bpm with Macintosh blade; 93.08±12.09, 94.54±11.87 and 87.50±10.72 bpm with McCoy blades; 108.20±13.94, 95.18±12.75 and 93.22±12.32 bpm with Miller blades. Rise in heart rate as well as mean arterial pressure following intubation was greatest with Miller blade, followed by Macintosh blade and least with McCoy blade and was statistically significant (P< 0.01).

Conclusions: Miller blade produced maximum haemodynamic stress response, followed by Macintosh blade and McCoy blade produced the least haemodynamic response, hence the latter is preferable when less haemodynamic response is desired.
PEAK EXPIRATORY FLOW RATE AMONG SMOKERS AND NON-SMOKERS WORKING IN KATHMANDU MEDICAL COLLEGE
Authors: Gurung Preetu
Published: May 2022

Background: Cigarette smoking has remained a popular habit since ages. Most people are well aware of the deleterious effects of cigarette smoking yet continue to give a blind eye which dete­riorates overall public health. The purpose of the present study was to assess Peak Expiratory Flow Rate among smoking and nonsmoking staffs who work in Kathmandu Medical College.

Methods: In this comparative cross-sectional study Peak Expiratory Flow Rate was obtained using Mini Wright’s Peak Flow Meter of 108 smokers and 108 nonsmokers in the age group ranging from 25-45 years. Those who never smoked or who have quit smoking for the past 2 years were grouped as nonsmokers and the smokers with history of smoking at least five or more cigarettes per day for at least two years were included in the study for measuring their Peak Expiratory Flow Rate. Data was collected, compiled and analyzed by using Statistical Package of Social Science (SPSS) software version16. Student ‘t’ test was used for group comparison.

Results: The Peak Expiratory Flow Rate value was significantly reduced in the smokers (p value< 0.05). Mean Peak Expiratory Flow Rate was reduced with increasing age of the smokers. However, no significant difference was observed in Peak Expiratory Flow Rate with increase in the number of cigarettes smoked (p value> 0.05).

Conclusions: In the study Peak Expiratory Flow Rate among smokers (367.13 ± 74.182) was lower than nonsmokers (471.39±60.842), which was statistically significant proving that cigarette smok­ing reduced peak expiratory flow rate.
PROXIMITY OF MANDIBULAR THIRD MOLAR ROOTS WITH INFERIOR ALVEOLAR CANAL: A RADIOGRAPHIC STUDY
Authors: Kumar singh Ashutosh , Khanal Nikita , Dhungel Safal
Published: May 2022

Background: Mandibular third molar’s roots have close proximity to the inferior alveolar canal (IAC) and nerve. Inferior alveolar nerve injuries have been observed to occur more frequently when there is radiographic evidence of close contact of third molar roots to the IAC. Orthopan­tomogram is one of the commonly used diagnostic tools for evaluating the relationship between these two structures. There is lack of data regarding prevalence of these radiographic signs in Nepalese population. It was required to assess the reliability on the radiographic signs of relation­ship between the IAC and the third molar roots, to establish IAC as risk indicators for IAC exposure during extraction.

Methods: A single centre cross-sectional descriptive study was designed where demographic data and radiographic signs of third molar roots proximity to IAC were obtained from imaging software records and descriptive analysis was performed with SPSS version 20.

Results: One or more radiographic signs were observed in 49.6% of mandibular third molars. In­terruption of white line followed by narrowing of canal and darkening of roots was observed in decreasing order of frequency and no statistically significant association between sex, age and side of impacted third molar with presence of radiographic signs.

Conclusions: Presence of one or more radiographic signs of proximity of mandibular third molar roots with IAC in nearly half of the cases. Clinicians should be aware of risk of nerve injury on pres­ence of these signs. Further investigation with cone beam computed tomography to rule out any nerve injury risk should be adopted into practice.
ORAL PEMPHIGUS VULGARIS: A CASE REPORT
Authors: Baral Radha , Ojha Bidhata , Bajracharya Dipshikha
Published: May 2022

Pemphigus vulgaris is an autoimmune blistering disease clinically presenting as vesicles, bullae and erosion on the skin and mucous membrane. Histopathologically, it is characterized by acantholy­sis and supra basilar split. The underlying mechanism causing intra epithelial split in pemphigus vulgaris is binding of IgG autoantibodies to desmoglin 3 which belongs to a transmembrane gly­coprotein adhesion molecule. Here we present a case of 27 years old male patient suffering from pemphigus vulgaris. This Case report highlights the importance of detailed case history, thorough clinical examination and appropriate investigation to reach a diagnosis of vesiculobullous lesion.
PHYSICAL, CHEMICAL AND MICROBIOLOGICAL ANALYSIS OF BOTTLED WATER IN POKHARA, NEPAL
Authors: Maskey Manisha , Annavarapu Laxminarasimha Sharma , Prasai Tista , Bhatta Dharma Raj
Published: May 2022

Background: Today possibility of rendering water non-potable by various types of contaminants (physical, chemical and biological) is of considerable importance. It is not only the microbial con­taminants but also the physical and chemical contaminants, playing an important role in compro­mising our health in many ways. The aim of this study was to assess the physical, chemical and the microbiological quality of commercially produced bottled water in Pokhara city.

Methods: A study was conducted to assess the quality of bottled drinking water produced in Pokhara city. Total of 21 brands of bottled water was collected, first batch in monsoon season and second batch in pre-monsoon season, from the market. The physical, chemical and microbial as­sessment was carried out as per National Drinking Water Quality Standards, 2062. Coefficient of variation and t-test were applied where applicable.

Results: Better water quality was found in Pre-monsoon season than that of monsoon season, in regard to microbial assessment. None of the samples in first batch tested positive for coliform whereas in second batch 38.2% of samples tested positive for coliform. Coefficient of variation for pH and chloride content was, 8.9% and 6.1%, 35.6% and24.19%, in pre-monsoon and monsoon season respectively. Both were found to be statistically significant. While other tested parameters were within normal limits.

Conclusions: The quality bottled drinking water available for sale do not meet the standards given by National Drinking Water Quality Standards, particularly the microbial quality.
NURSES’ KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING POSTOPERATIVE PAIN MANAGEMENT AT SELECTED HOSPITALS, BHARATPUR, NEPAL
Authors: Thapa Rupa Devi , Gurung Ganga
Published: May 2022

Background: Acute and severe pain after surgery is the major concern of operated patients and health professionals where the vital responsibilities goes to the nurses for managing pain satisfactorily. Hence, the nurses require to have adequate knowledge, attitude and practice (KAP) to carry out such responsibilities.

Methods: A descriptive cross-sectional study design was used to find out the nurses’ KAP regarding postoperative pain (POP) management. Total 74 nurses of postoperative wards were selected from four hospitals at Bharatpur with non-probability enumerative sampling technique. Data were collected with the structured self-administered questionnaire for knowledge, five-point Likert scale for attitude and observation checklist for practice. Data were analyzed by using descriptive statistics for levels of KAP; Chi-square for association between levels of KAP with selected variables and spearman rank correlation to determine relationship among KAP regarding POP management.

Results: The study showed that 85.1% nurses had low level of knowledge, 55.4% had satisfactory level of attitude and 52.7% had low level of practice. Statistically significant association was found between level of practice and age (p=0.010) of nurses and with professional qualification (p=0.002). There was no statistically significant relationship among KAP scores regarding POP management.

Conclusions: Majority of the nurses had low level of knowledge, more than half had satisfactory level of attitude but low level of practice regarding POP management. The age and the professional qualifications of the nurses found to be associated with the practice of POP management.
EFFECTIVENESS OF NURSES-LED CARDIAC REHABILITATION PROGRAM AMONG CORONARY ARTERY DISEASE PATIENTS ATTENDING A TEACHING HOSPITAL, BHARATPUR
Authors: Shrestha Rosy , Rajbanshi Laxmi , Singh Jaya Prasad , Shrestha Kshitiz , Shrestha Sajeeb
Published: May 2022

Background: Cardiac rehabilitation (CR) is a comprehensive secondary prevention program, de­livered by multidisciplinary team including nurses. This portion in health care sector is found to be lacking and communication between health care providers and cardiac patients is frequently suboptimal. The aim of this study was to identify the effectiveness of nurse-led cardiac rehabilita­tion program among coronary artery disease patients attending a teaching hospital in Bharatpur, Nepal.

Methods: One group pre-test post-test design was used. Total 85 CAD patients were selected for pre and post-test, baseline information was collected using consecutive sampling technique. The educa­tion intervention on CR was developed in Nepali language and distributed to each respondent after pre-test in separate room of OPD of Chitwan medical college and teaching hospital, Bharatpur. After one month of education intervention program, post-test was conducted with same subjects using face to face interview questionnaire using CADE-Q. Data was analyzed using Wilcoxon Rang signed test.

Results: Of all 85 respondents, median difference between pre-test was 17 (IQR=14-22) and post-test was 39 (IQR=32-44) which was statistically significant (p=<0.001). The percentage of respondents with non-acceptable level (<50%) of knowledge sharply declined from 96.4% to 11.7% whereas those with acceptable knowledge (≥50%) significantly increased to 3.53% to 88.2% at p value <0.001.

Conclusion:The nurse-led educational intervention programme considerably improved the knowl­edge on Cardiac Rehabilitation among CAD patients. Hence, it is strongly recommended that nurses should be involved in establishing and organizing cardiac rehabilitation programs at each tertiary level hospital in Nepal.
SOCIO-DEMOGRAPHIC PROFILE OF PATIENTS SUFFERING FROM DEPRESSIVE DISORDER ATTENDING PSYCHIATRY OUT PATIENT DEPARTMENT
Authors: Niroula Riju , Upadhyay Hari Prasad
Published: May 2022

Background: Depression is one of the most common mental disorders responsible for consider­able morbidity, disability and decreased quality of life. The socio-demographic factors have con­sistently been identified as important factors in explaining the variability in depression prevalence rates. This study was aimed to evaluate the relationship between depression and these socio-demographic factors.

Methods: A descriptive cross-sectional study was conducted among 110 patients above 18years of age of both sexes who met the criteria for diagnosis of Depressive disorder as per ICD-10 DCR in the Psychiatry Outpatient Department of College of Medical Sciences Teaching Hospital, Bharat­pur, Nepal. A self- designed semi- structured proforma was developed to obtain the socio-demo­graphic variables and the data were analyzed.

Results: Mean age of the patients was 35.61±10.83 years and 62.7% of the patients were females. Married people (65.5%) tended to develop depression compared to unmarried people (25.5%). Rural residents (67.3%) were more prone to suffer from depression than urban residents (32.7%). Most of the patients were illiterate (54.5%) and unemployed (29.1%). Majority were of Hindu (71.8%) religion, Brahmins (27.3%) caste and from lower socioeconomic status (58.2%).

Conclusions: This study shows that socio-demographic factors such as age, gender, marital status, residence, level of education, occupation and socioeconomic status were positively associated with depression. This strong association between depression and socio-demographic status which may have long been overlooked may play an important role to understand and treat the disease.
STRESS AND STRESSORS IN FEMALE MEDICAL AND DENTAL STUDENTS AT KATHMANDU MEDICAL COLLEGE
Authors: Kharel Sushil , Raut Binod
Published: May 2022

Background: Stress is a physical, mental or emotional factor that causes bodily or mental tension. Stress upsets an individual both mentally and physically. Study showed that medical students suf­fer from higher stress than other stream students. Among medical students also female students are more prone to stress due to varied reasons. This study aimed to determine the stress among female medical and dental undergraduates.

Methods: This cross-sectional study was designed to evaluate and assess the levels of perceived stress and common stressors among female medical and dental students at a teaching institute of Kathmandu, Nepal. A cross-sectional study was done to the first- and second-year undergraduate female medical and dental students. Perceived stress was evaluated using universally accepted Cohen’s Perceived Stress Scale (CPSS-10).

Results: A total of 176 female medical and dental students were enrolled in the study. The mean COHEN PSS score was found to be 27.97 (SD 4.32) which showed high stress among study popula­tion. Fifty nine percent (59%) of the female medical and dental students had perceived stress.

Conclusions: Levels of perceived stress were very high in female students. The most common stressors were related to educational and economic concerns. The students were more focused to daily matters and problems related to their academic achievements.
FOOT INDEX: IS IT A TOOL FOR GENDER DETERMINATION AMONG NEPALESE POPULATION?
Authors: Mansur Dil Islam , Karki Raj Kumar , Shrestha Pragya , Mehta Dilip Kumar , Maskey Sunima , Dahal Shreya
Published: May 2022

Background: The human foot shows variations in its dimensions and shape in different age group of both male and female. It can be used as gender predictor of an individual in forensic science investigations which may have a great value for identification of unknown deceased body. This study was aimed to measure the various dimensions of foot and derive a tool to predict gender of an individual.
Methods: This study was the cross-sectional type which consisted of 556 individuals (268 males and 288 females). Foot dimensions (foot length and foot breadth) were measured in centimeter and the foot index was derived for both sexes separately. The data was analyzed using descriptive statistics with SPSS vesion 20.0.
Results: It was concluded that there were gender differences in foot length and breadth. The foot length and foot breadth were found to be higher among males than females. The bilateral differences of foot dimensions were not recorded in both male and female. There were gender differences in foot index.
Conclusions: The male is found having longer and broader foot than female foot. The foot index is not used as an appropriate tool to determine gender.
STUDY OF CLINICAL SPECTRUM OF GERIATRIC DERMATOSES IN PATIENTS ATTENDING A MULTI-SPECIALTY HOSPITAL
Authors: Jha Harendra Kumar
Published: May 2022

Background: The spectrum of skin disease is unique in geriatric population and also varied according to geographical areas. It is emerging major health problem in person above 60 years of age, since the overall life expectancy is increasing. There is not much data on skin disease in geriatric population of Nepal. The study aimed to identify the prevalence and clini­cal characteristics of geriatric dermatoses in a multi-specialty hospital set up.
Methods: All patient attending dermatology OPD above 60 years of age and fitting the inclusion criteria were taken in to the study. A detailed history, physical exam and relevant laboratory in­vestigation was done to make a diagnosis. The data collected was entered in Excel and descriptive analysis was done by SPSS version 22.
Results: The number of elderly patients was 235 out of 3292 (7.13%). Altogether 246 diagnosis was made in 235 patients which had male preponderance of 53.19%. The pre-dominant diagno­sis was skin infection and infestation (38.61%), followed by eczema or dermatitis (18.69%) and papulo-squamous disease (11.78%). Other common conditions seen were urticaria (4.87%), pho­todermatoses (4.87%), senile xerosis (4.87%) and miliaria (3.65%).
Conclusions: Cutaneous infections and infestations were the commonest dermatoses followed by eczema/dermatitis. Fungal infection, allergic contact dermatitis, psoriasis were among common dermatoses. No cases of skin malignancy were found. Elderly population in Nepal is increasing and epidemiological data provide government and health care provider to address their problem in effective way.
REVERSE SURAL ARTERY FASCIOCUTANEOUS FLAP IN SOFT TISSUE RECONSTRUCTION IN LOWER EXTREMITY
Authors: Pandey Suresh , Bidary Suraj
Published: May 2022

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg.
Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0.
Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics.
Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.
PREVALENCE OF CORACOCLAVICULAR JOINT IN PATIENTS VISITING RADIO-DIAGNOSIS DEPARTMENT AT COLLEGE OF MEDICAL SCIENCES, CHITWAN
Authors: Pandit Ruku , Shrestha Sunara , Sharma Nitasha
Published: May 2022

Background: Coracoclavicular joint (CCJ) is a true synovial joint between superior surface of coracoid process of scapula and conoid tubercle of clavicle. The radiological prevalence of CCJ in various population ranges 0.55% to 21%. The CCJ are mostly discovered incidentally and is rarely associated with any symptom. Sometimes it may present with shoulder pain, limitation of shoulder movement, upper limb paresthesia and osteoarthritis of itself or adjacent acromioclavicular joint. Hence, this study is aiming to determine the prevalence of anomalous CCJ in patient visiting department of Radio-diagnosis in College of Medical Sciences, Bharatpur, Chitwan, Nepal and to observe association of CCJ with laterality, sides and gender.

Methods: A total of 1936 digital chest x-rays films were observed for the presence of CCJ, out of which 1097 images were of male and 839 of females. Age of study population ranged from 3 to 90 years. The data obtained were analyzed using Stastical Package for Social Science version (SPSS) 16.0. The prevalence of CCJ was calculated. The cases with CCJ were further analyzed to evaluate the association of CCJ with laterality, sidedness and gender using Chi-square for one-dimensional "goodness of fit" test. Chi-square of Independence was employed to compare the various parameters (laterality and side) with genders.

Results: The prevalence of CCJ was 4.6%. CCJ was more frequently observed in male (67.42%) than female (32.57%). Unilateral occurrence of CCJ (55.06%) was slightly more than bilateral (44.94%). Gender difference was not significantly associated with laterality and sidedness of joint (p<0.05). The incidence of CCJ was more in group C (between 20 to 29 years of age) in both male and female.

Conclusions: CCJ is not rare, hence, knowledge of presence of CCJ as an etiology of shoulder pain is essential for rational therapy and will prevent misdiagnosis.
OSTEOMA OF MANDIBULAR CONDYLE: A CASE REPORT
Authors: Liaquat Ahmad , Baig Moghees Ahmad , Khan Saqib Mehmood
Published: May 2022

Condylar osteoma is a benign tumor involving the condyle of the mandible. It is a rare pathology of unknown etiology. It is thought that it may originate from either cartilage or embryonal periosteum. It is also possible that it may be a reactionary lesion triggered by trauma or infection. Here, we present a case report of a female patient aged 60 years with osteoma on the right condyle with trismus and facial deformity. We surgically removed the tumor using a pre-auricular approach.
REFLECTIONS OF MEDICAL INTERNS ON INTERNSHIP IN INTERNAL MEDICINE
Authors: Piryani Rano Mal , Piryani Suneel , Deo Gopendra Prasad
Published: May 2022

Background:Reflection and reflective practices are considered as one of the important components of medical education and imperative for self-directed lifelong learning. The objective of this study was to take reflections of interns what they learnt during posting in internal medicine and challenges they faced and what was gratifying moments. 

Methods:MBBS course in Nepal is of five and half years including one-year mandatory rotational internship of which 2 months posting in internal medicine. The Internship of first MBBS batch at Chitwan Medical College started in May 2015. At the end of last round of posting of first group within department of internal medicine, written reflections of all interns were taken. The data were streamlined manually and presented.

Results: Interns updated and enhanced clinical, report interpretation, correlating clinical condition with lab reports, decision making, management, documentation, counselling and communication skills for a limited time posted in medical wards, OPD, ICU, CCU and hemodialysis unit. Some of the challenges were dealing patients with different attitude, to become responsible trustworthy doctor, responding to expectations of patient and family and to keep patient informed. When patient believes and trusts on us and happily returns home were among the gratifying moments mentioned by interns. In fact, students were not taught about reflection during 4 and half years of study

Conclusions: Though interns reflected but approach was not systemic as they didn’t learn about reflection during course of study. Incorporate reflection as a teaching learning and assessment methods in curriculum, implement it and make reflective practice as core professional skill.
HISTOPATHOLOGICAL EXAMINATION OF TISSUES FOLLOWING A SURGICAL UTERINE EVACUATION IN THE FIRST TRIMESTER BLEEDING: CLINICAL RELEVANCE
Authors: Khanal Bandana , Sharma Basant , Tamrakar Renuka , Singh Prekshya
Published: May 2022

Background: There is no general consensus about the role of routine HPE of the obtained tissue at the time of uterine evacuation. However, it is understood clinically that it is of utmost importance to prove the presence of intrauterine gestation and to exclude gestational trophoblastic disease in the form of partial or complete mole. This study aimed to assess the role of histopathology in cases of first trimester miscarriages and to determine clinical relevance of histopathological examination following surgical evacuation.
Methods: This was a retrospective study of collected data over 12 months (January 2018- De­cember 2018) in an agency for reproductive health setup with predefined inclusion criteria. We included 60 consecutive patients attended with history of first trimester bleeding. Patient’s record and the histopathological examination report of products of conception following uterine evacu­ation were observed. The data was analyzed descriptive statistics including percentage, stander deviation, mean, and range in Microsoft Excel software.
Results: Missed abortion was the most common type and constituted 55% of the studied group. The histopathological reports confirmed the pregnancy in all patients and revealed partial mole in 6(10%) patients and complete mole in 2(3.33%) patients.
Conclusions: Histopathological examination of products of conception detects under diagnosed molar pregnancies that necessitates special follow up and is a key step to do further management.
OSTEOSARCOMA OF THE MANDIBLE DEVELOPED AFTER TOOTH EXTRACTION TREATED WITH SURGERY- A CASE REPORT
Authors: Shah Arun Kumar , Riaz Nabeela , Thakurathi Deepak , Liaquat Ahmad
Published: May 2022

Osteosarcoma of jaw is a rare malignant condition of osteoid tissue with same histopathological features but different biological behaviour compared to long bone. It has characteristic clinical, radiographic and histopathologic features and treatment after early diagnosis followed by surgery (with negative margin) combined with chemotherapy or radiotherapy has better prognosis and survival rate. Here we report the case of osteosarcoma of mandible after tooth extraction in a 55-year-old female and treated by surgery.
KNOWLEDGE ON ACUTE KIDNEY INJURY AMONG NURSES WORKING IN A TERTIARY HOSPITAL
Authors: Sapkota Abja , Sedhain Arun , Karki Usha
Published: May 2022

Background: Nurses can play a pivotal role to identify and prevent acute kidney injury (AKI) at the earliest and their level of understanding about the disease remains quite important. So, this study was conducted with an aim of assessing the level of understanding of AKI among nurses.
Methods: A cross-sectional descriptive study was conducted among 122 nursing staffs working at different wards of a tertiary hospital. Knowledge on AKI was evaluated on different headings-definition, risk factors, bed side nursing observations, and supportive care. Semi-structured ques­tionnaire was used to collect the responses through self-administered method. Analysis was done through frequency, percentage median, chi-square test and through odds ratio using Microsoft Excel and SPSS version 16 for windows.
Results: A total of 122 nurses were included in the study. Mean age of the respondents was 26.7±5.88 years. Only 43.4% of the respondents could correctly define AKI on the basis of creati­nine value. Non-steroidal anti-inflammatory drugs (NSAIDs) and aminoglycosides as nephrotoxic drugs could be listed by 59.8% and 23.7% of the respondents respectively. About 40% of the nurses mentioned the requirement of observation of both intake and output as a part of management of AKI. Overall, 53.3% of the nurses were found to have an inadequate knowledge of AKI.
Conclusions: Inadequate knowledge of AKI among nurses can hinder the early recognition and management. Therefore, there seems to be a strong need of formal and structured refreshing course for the nurses to provide current updates on identification, risk assessment, recognition and response of AKI.
LATE ONSET CAPSULAR BLOCK SYNDROME AFTER MANUAL SMALL INCISION CATARACT SURGERY: A CASE REPORT
Authors: Sahu Sabin , Singh Sanjay Kumar , Luitel Pragya , Yadav Reena , Priya Bhadra , Hemant Sharad
Published: May 2022

Capsular block syndrome is a rare complication of cataract surgery seen with continuous curvilin­ear capsulorrhexis and in-the-bag placement of posterior chamber intraocular lens. We report an uncommon case of late postoperative fibrotic capsular block syndrome with posterior capsular opacification in an adult Nepali patient after uneventful manual small incision cataract surgery which was successfully treated with Nd: YAG laser capsulotomy without any complications.
GALLSTONE ILEUS WITH MULTIPLE GALLSTONES: A CASE REPORT
Authors: Sitaula Deekshanta , Adhikari Sanjit , Bhattarai Abhishek
Published: May 2022

Gallstone ileus is a rare complication of gallstones and an unusual cause of intestinal obstruction. It typically occurs due to formation of cholecystoduodenal fistula and patients usually present with features of small bowel obstruction. The mainstay of treatment is to relieve the intestinal obstruction with surgical removal of impacting gallstone. Here, we report a case of a male patient presented with features of small bowel obstruction. CT of abdomen demonstrated presence of air in the gallbladder, small bowel obstruction with direct communication of the gallbladder with 1st part of duodenum and multiple calculi in proximal jejunal loops, features suggesting gallstone ileus. The patient underwent exploratory laparotomy and removal of four gallstones via enterotomy. He was discharged after an uneventful postoperative course. The aim of this case report is to report a new unusual case of gallstone ileus and discuss its diagnostic and surgical approaches. Though uncommon, gallstone ileus should always be kept in mind when approaching a case of small bowel obstruction, especially in elderly patients and in patients with known gallstone disease.
PRIMARY CUTANEOUS MUCORMYCOSIS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT
Authors: Paudel Deepak , Dahal Raunak , Khadka Dhan Kesar , Agrawal Yamuna
Published: May 2022

Zygomycosis is an infrequently encountered locally invasive, aggressive fungal infection that frequently occurs in patients with an underlying immunodeficiency. It is usually diagnosed on histopathology and treated with systemic antifungals. We report a case of 16 years old female who presented with swelling on the dorsum of nose with overlying redness and tenderness. As she did not respond to antibiotics and conventional treatment, computed tomography (CT) scan and fine needle aspiration cytology (FNAC) were performed which revealed an inflammatory lesion. However, her histopathological examination was a surprise for all of us as it came out to be zygomycosis. She was started on oral antifungal, and responded well. Although a rare entity, primary cutaneous zygomycosis should always be kept in mind while evaluating any swelling if it doesn’t improve on conventional treatments and dealt accordingly.
AN UNUSUAL CAUSE OF INTRAOPERATIVE HIGH AIRWAY PRESSURE AND VENTILATOR FAILURE: MESSAGE TO BE LEARNED
Authors: Shrestha Anil , Parajuli Bashu Dev , Tiwari Pradip , Limbu Trishant
Published: May 2022

Failure of ventilation of an anesthetised patient due to problems in mechanical ventilator isnot uncommon. The proper functioning of machine should be ensured before anesthetisinga patient by the automated checking system or manually by the attending anaesthesiologist.However, sudden malfunction of some system of the machine during operation may causethe ventilator to stop risking the patient’s life. About one third of the equipment problemsare due to anesthesia machine and one quarter of the problems are due to human error. Wepresent a case of malfunction of anesthesia ventilator due to an unusual cause of blockage ofanesthesia gas scavenging system.
PREVALENCE OF PREHYPERTENSION AND ITS ASSOCIATION WITH BODY MASS INDEX AMONG THE MEDICAL STUDENTS
Authors: Bhaila Archana , Shakya Binnam , Nepal Grishma Banskota , Shrestha Hari Sunder , Maharjan Niroj , Adhikari Bijaya
Published: May 2022

Background: Prehypertension in adolescents is an important risk for developing hypertension in later years of life. Hypertension is one of the major cardiovascular problems in urban and suburban areas of Nepal and is increasing among the young population. There are not many studies reported in Nepal which estimates the prevalence of hypertension among medical students. Hence, this study aimed to assess the prevalence of prehypertension and its association with body mass index so that it would assist in developing strategies for control of hypertension and cardiovascular diseases in later years of life
Methods: This cross-sectional study included 250 medical students. Anthropometric variables of the subjects were recorded. Height and weight were measured on calibrated scales and body mass index was calculated. Waist and hip measurements were obtained and waist-hip ratio was calculated. Blood pressure was measured with a mercury sphygmomanometer. The data obtained was divided into different groups according to blood pressure and BMI. Descriptive statistics, chi-square test was used for presenting data and testing the significance and P<0.05 was considered as statistically significant.
Results: The prevalence of normotensive, prehypertensive and hypertensive students was found to be 75.2%, 20.8% and 4% respectively. Mean BMI was found to be 21.59±3.39. In general, 75.2% of the students had ideal waist hip ratio, 15.2% were underweight, 70 % had normal weight, 12 % were overweight, and 2.8% were found to be obese. Moreover, 51.4% of prehypertensives had BMI more than 25. Prehypertension was significantly higher among males (χ2=16.385, p<0.001) and among the obese medical students (χ2=16.416,p<0.001).
Conclusions: Prehypertension is prevalent in about a third of medical students and BMI is found to be significantly associated with pre-hypertension.
MORPHOMETRIC STUDY OF LUMBAR VERTEBRAL PEDICLES
Authors: Khatiwada Sushma , Sudhin Buddhi Nath Adhikari , Pandey Neeraj , Shrestha Iju , Dhungel Deepesh
Published: May 2022

Background: Pedicle screw instrumentation has revolutionized spine surgery on account of its superiority over other stabilization systems. It is safe when properly placed and versatile for a range of procedure from fracture fixation to complex deformity correction. Sound anatomical knowledge of the pedicle may also be helpful during surgical approach to lumbar foramina disc herniation and epidural steroid injection as well as in the diagnosis of some lumbar degenera­tive diseases and chronic back pain. In this study we aimed to provide locoregional data on lumbar pedicle morphometry of Nepalese population.
Methods: A descriptive observational study was conducted on 50 dry adult human lumbar vertebrae of unknown sex at Chitwan Medical College from August 2020 to December 2020. Pedicular width, height and the interpedicular distance were measured. All the data were numerally coded in excel and analysis was done in Statistical Package for Social Sciences (SPSS) version 20.
Results: The mean width of the pedicles of left side gradually increased as we moved down the vertebrae and measured 7.43 ±0.84 mm in L1 and 12.18±1.71 mm in L5 vertebrae. The mean width of the pedicles on the right side, however, showed an increasing trend with a lower value at L3 level and was measured as 7.91± 1.17 mm. The mean height of the pedicles alternatively decreased and increased down the vertebrae for both the sides. The mean interpedicular distance gradually in­creased craniocaudally and was found to be 20.35±0.95 for L1 and 25.97±3.58 mm for L5 vertebrae.
Conclusions: This study confirmed the measurement of lumbar pedicles’ dimensions and provides its regional data on Nepalese population. These data may be critical for clinicians working near the vicinity of the lumbar pedicles.
EFFECT OF PHOTOTHERAPY ON HEMATOLOGICAL PROFILE OF NEWBORNS WITH UNCONJUGATED HYPERBILIRUBINEMIA
Authors: Timilsina Mukunda , Gauchan Eva , BK Ganesh
Published: May 2022

Background: Phototherapy despite being very safe is found to be associated with various untoward effects. The objective of this article was to study the changes in various hematological parameters as a result of phototherapy in neonates treated for unconjugated hyperbilirubinemia.
Methods: A cross sectional study was conducted in 120 neonates with unconjugated hyperbilirubinemia to determine the changes in the blood cell counts. We compared the complete blood counts at the time of admission and after 48 hours of phototherapy. The data was analyzed in SPSS 25 using paired t test.
Results: We observed that there was an increase in the lymphocyte counts from 5,650 cells/mm3 before phototherapy to 6,360 cells/mm3 after phototherapy with a p-value 0.028. MCH increased from 32.22 pg before phototherapy to 33.34 pg after phototherapy with a p-value of 0.018. The mean monocyte counts decreased from 730 cells/mm3 before phototherapy to 530 cells/mm3 after phototherapy with a p-value of 0.016. The mean platelet count also decreased from 241×103 cells/mm3 to 258×103 cells/mm3 with a p-value of 0.041 which was significant. Rest of the blood cell counts seem to be unaltered by phototherapy.
Conclusions: Phototherapy was found to be associated with significant decrease in the absolute monocyte count and platelet counts and caused an increase in the lymphocyte count and MCH. However, it does not cause significant changes in the total count and hemoglobin levels.
PHARMACOLOGICAL MANAGEMENT OF ACUTE RESPIRATORY TRACT INFECTIONS IN EMERGENCY DEPARTMENT OF TERTIARY CARE CENTER
Authors: Ruchi Shrestha  , Shrestha Roshana , Shrestha Sony Shakya , Manandhar Jyoti Tara
Published: May 2022

Background: Acute respiratory tract infection has been recognized as the major cause of morbidity and ranks among the most frequent causes of mortality among the elderly and very young children. This study aimed to assess the pharmacological management of acute respiratory tract infections among patients visiting Emergency Department in Dhulikhel Hos­pital, Kathmandu University Hospital.
Methods: A descriptive, cross sectional study was conducted from August 2019 to January 2020 in patients attending Emergency Department of Dhulikhel Hospital. One hundred and sixty five pa­tients with symptoms of acute respiratory tract infections who visited the same department were included in the study. Entry and analysis of collected data was done in Statistical Package for the Social Sciences 20. Descriptive tests were used, and results were expressed as mean, frequency and percentage.
Results: Among 165 patients who visited Emergency department with symptoms of acute respira­tory tract infections, majority 137 (83%) had symptoms of shortness of breath, followed by cough 110 (66.7%). Thirty (18.2%) cases were triaged into high acuity (red) zone. Acute exacerbation of chronic obstructive pulmonary disease 118 (71.5%), followed by pneumonia 16 (9.7%) were the most common diagnosis. Intravenous hydrocortisone was the most commonly used pharma­cotherapy in 125 (75.8%) patients. Oxygen was most commonly used supportive therapy in 137 (83%) cases. Regarding the outcome, 75 (45.5%) were admitted to wards and 64 (38.8%) were discharged.
Conclusions: Most of the acute respiratory tract infections were managed by using intravenous corticosteroid, antibiotics and nebulized bronchodilators.
COMPARISON OF UPPER LIP BITE TEST AND MODIFIED MALLAMPATI TEST FOR PREDICTION OF DIFFICULT INTUBATION
Authors: Devkota Kriti , Adhikari Kiran
Published: May 2022

Background: Insertion of endotracheal tube is the basic skill acquired by all anesthesiolo­gists. An unanticipated difficult intubation can be catastrophic and is one of the major causes of morbidity and mortality in anesthetic practice. So, there are multiple screening tests de­signed to correctly predict difficult intubation but none of them are 100 % accurate. The study aimed to compare the Modified Mallampatti test with Upper Lip Bite test for correct prediction of difficult intubation.
Methods: A cross-sectional study was conducted in the College of Medical Sciences, Bharatpur from 16th June 2020 to December 31st 2020. A total of 610 patients requiring general anesthe­sia with endotracheal intubation were included in the study. The Modified Mallampatti test and Upper Lip Bite test along with laryngoscopy was performed by an experienced anesthesiologist. Sensitivity, specificity, accuracy and positive and negative predictive values for both tests were calculated and compared.
Results: The incidence of difficult intubation was 17.7% in our study. The upper lip bite test showed better sensitivity (79.63% vs 37.96%), specificity (93.82% vs 69.92%), positive predictive value (73.5% vs 21.35%), negative predictive value (95.53% vs 83.97%) and accuracy (91.31% vs 64.26%) compared to Modified Mallampatti test
Conclusions: Upper lip bite test was a better predictor of difficult intubation compared to MMT with higher accuracy and predictive values.
NEGLECTED TROPICAL DISEASES: EMBRACING THE NEW ROADMAP
Authors: Shrestha Niki
Published: May 2022

N/A
ULTRASONOGRAPHY IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Chhetri Pramod Kumar , Basnet Subas Bahadur
Published: May 2022

Background: Chronic kidney disease can be defined as kidney damage for > 3 months as evidenced by structural or functional abnormalities. Ultrasonography is the initial imaging modality employed in kidney disease. This study was undertaken to compare various sonographic parameters of the kidney with serum creatinine level and to establish the reliability of ultrasonography for estimating severity of kidney damage.
Methods: This was a hospital based cross-sectional study on 60 patients with known chronic kidney disease who were advised for ultrasonography in the Department of Radiodiagnosis, COMS-TH during one-year period from Feb 2017 to Jan 2018. The serum creatinine level of each patients was compared subjectively to the renal cortical echogenicity. Other parameters like cortico-medullary differentiation and morphological parameters including kidney length, parenchyma thickness, and cortical thickness were also measured. Data analysis was done using SPSS 20.0 software program. The statistical correlations between sonographic parameters and serum creatinine were calculated using one-way analysis of variance (ANOVA) followed by Scheffe’s test.
Results: Renal cortical echogenicity in patients with chronic renal disease showed a significant positive correlation with serum creatinine (F = 120.93; p<0.001). Other parameters like renal length (r = -0.933; p<0.001), parenchymal thickness (r = -0.945; p<0.001) and cortical thickness (r = -0.980; p<0.001) also showed significant but negative linear correlation with serum creatinine.
Conclusions: Ultrasonography parameters like cortical echogenicity, renal length, parenchymal and cortical thickness can be used along with serum creatinine for estimating severity of renal damage in chronic kidney disease.
DOUBLE BALLOON ENTEROSCOPY: OUR INITIAL EXPERIENCE AT UNIVERSITY TEACHING HOSPITAL
Authors: Kafle Bhandari Brindeswari , Pathak Rahul , Jha Anurag , Hamal Rabin , Koirala Dinesh , Bhusal Mohan
Published: May 2022

Background: Double Balloon Enteroscopy (DBE) is a standard method of assessing small bowel pathologies. It acts as a complimentary diagnostic tool in evaluating diseases of entire small bowel with varying diagnostic yields. These days, most of the advanced endoscopic centers provide DBE services. Here, we aimed to evaluate our initial experience in performing the DBE procedures in endoscopic unit of department of medical gastroenterology.
Methods: Retrospective review of prospectively maintained medical records of all the patients undergoing DBE procedure over two years period (between Jan 2018- Dec 2020) were analyzed. The general demographics, indication, insertion routes, findings and any associated complications reported.
Results: During study period, 50 DBE diagnostic procedures were performed. Youngest was 16years while oldest patient was 83years. Commonest indication was small bowel bleeding (28%, 14) fol­lowed by iron deficiency anemia in 24% (12). In 48% (24) complete procedure by both anterograde (oral) and retrograde (anal) route was performed. Commonest finding was small bowel ulcer in 16 patients followed by erosions (5) and diverticulum (5). Only in one patient, the vascular malforma­tion was revealed. Commonest procedure related complication was abdominal discomfort (50%) which resolved on its own. There was no major complication and no procedure related mortality.
Conclusions: DBE is a safe diagnostic procedure in evaluating small bowel pathologies; the com­monest usefulness is in patients with either occult or overt SBB. However, the procedural complex­ity and long procedure times are still considered as obstacles in incorporating the DBE as routine services.
TREATING COMPLETE DENTURE PATIENTS WITH XEROSTOMIA: KNOWLEDGE, ATTITUDE AND CLINICAL MANAGEMENT AMONG DENTAL PRACTITIONERS OF CHITWAN
Authors: Khanal Bibek , Thakur Smriti Narayan , Sapkota Srijana Mishra , Joshi Kalit Raj , Pokhrel Sushil
Published: May 2022

Background: The absence or decreased amount of saliva in the oral cavity can cause severe discomfort to patients wearing complete denture like decreased denture stability and retention, ulcerations in the denture bearing tissues to name a few. This questionnaire-based study was conducted among dentists practicing in Chitwan, Nepal to find out their knowledge, attitude and management of complete denture patients with xerostomia.
Methods: A cross-sectional study was performed among dentists in Chitwan. In total 103 dentists participated in this study. Descriptive statistical analyses were performed on the responses given by the dentists using SPSS Statistical Software package (version 21.0).
Results: A total of 103 returned questionnaire were included in the study. Out of the responses analyzed, 99.02% (n=102) have heard about hyposalivation in patients who wear complete denture while 63.86% (n=62) of the respondents think that females suffer more often with xerostomia and 94.17% (n=97) respondents think unretentive denture and denture instability may be due to xerostomia. Likewise, 86.4% (n=89) of the respondents are aware of various tests to diagnose xerostomia and the same number of respondents have knowledge about drugs to treat hyposalivation in complete denture patients and role of salivary stimulants. Likewise 83.4% (n=86) of the respondents are aware of role of denture adhesives in managing such patients.
Conclusions: From the responses obtained it can be concluded that the dentists of Chitwan have satisfactory knowledge about treating complete denture patients suffering from xerostomia.