Journal of Lumbini Medical College (JLMC) is a biannually, peer reviewed, open access, indexed, scientific medical Journal published in English by Lumbini Medical College in Palpa, Nepal. Subjects covered include all aspects of health and diseases including clinical and experimental studies and medical education (in the form of original full papers, short communications, critical reviews, editorial commentaries, conference summaries and book reviews).
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Antenatal to Postnatal: Assessing the Continuum of Maternal Health Service Utilization in Palpa, Nepal.
Introduction: One of the most prioritized programs of Government of Nepal is maternal health. Optimum utilization of maternal health services during pregnancy, delivery and post-natal period is an effective approache to reduce the maternal morbidity and mortality that helps us achieve the sustainable development goals target. This study aimed to assess the utilization of maternal health services including antenatal, intranatal and postnatal services among women in the Palpa district of Nepal. Methods: A descriptive cross-sectional study was conducted among 168 mothers in their reproductive age using a convenient sampling method. The study included those mothers who had a delivered a child in the past two years, in Palpa district. The data collection commenced from March to September 2023. The data analysis was conducted using Statistical Package for Social Sciences software (v 21.0). Results: A remarkable finding in the present study was 88.1% of mothers had utilized a minimum of four antenatal check-ups, as recommended by the Government of Nepal. Out of 168 mothers included in the present study 89.9% had institutional delivery while the remainder had home delivery. Post-natal check-ups following delivery was surprisingly uncommon as it was observed that only 28% mothers sought such care. Adequate utilization of maternal health services is influenced by factors such as proximity of health facilities, education level, and knowledge of maternal incentives. Conclusion: While service utilization for pregnancy and delivery in Palpa district aligns with national standard, further research is needed to identify factors contributing to underutilization of postnatal services.
Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum
Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice.
Hemispheric Brain Preference and Academic Parameters in Medical Students: A Cross-sectional Study
Introduction: Hemispheric brain preference means using one side of the brain over the other to learn. Hemispheric brain preference may influence one’s learning style. This study aimed to investigate hemispheric brain preference and its relation with academic parameters in medical students. Methods: Four hundred participants were included in the study by cluster random sampling. Using self-administered questionnaires, data on personal profile (name, age, sex, handedness, academic score, study method, study hours per day and study pattern) and hemispheric brain dominance was collected. Open Hemispheric Brain Dominance Scale 1.0 (2015) was used to determine the hemispheric brain dominance. Result: Participants having no clear hemispheric brain preference (46.75%) were in majority followed by those with left hemispheric brain preference (29.25%) and then those with right hemispheric brain preference (24%). There was a statistically significant difference in academic score of students with different hemispheric brain preference (p=0.021). Students with left brain preference had the highest academic score (63.85±11.78) and those with no clear preference had the lowest (59.96±11.64). Also, students with left hemispheric brain preference would study more regularly and would spend more time in study per day. Conclusion: In our sample, participants with left hemispheric brain preference were found to have the highest mean academic score but they also spent more time in study and also studied regularly throughout the semester. As this study shows diversity in brain preference among medical students, we recommend a good mix of various teaching learning methods for better learning of the entire class.
Nasal Parameters and Facial Index in Medical Undergraduates: A Cross Sectional Study
Introduction: Face has priority in identification of an individual. Nose occupying the middle of face is an important sense organ that helps in respiration. Nose and face can be classified into different types according to nasal index and facial index. The aim of this study was to analyze nose and face type and find out its dominance in different sex of Nepalese and Indian population. Methods: This was a quantitative observational study conducted on 156 medical students using simple sampling method. Data were collected then nasal index and facial index were calculated. Descriptive statistical data i.e. mean, standard deviation, together with the independent-samples t-test results for anthropometric variables of nasal and facial parameters in sex and Nationality (Nepalese and Indian) were analyzed. Results: All the measurement values were more in males compared to females, but the sexual dimorphism in nasal index (male 76.25 ± 7.75, female 75.70 ± 8.05) and facial index (male 85.77 ± 8.1, female 82.97 ± 7.63) is not statistically significant. Chi-square test revealed significant difference in face type among Nepalese and Indian population. Mesorrhine was the most common type of nose in both the population. Nepalese had commonly euryprosopic type of face while Indians had hypereuryprosopic type of face. Conclusion: Sexual dimorphism was not significant in both nasal and facial parameters while type of face was helpful in differentiation of Nepalese and Indian population.
Paradigm Shift in Gynecological Surgeries Over Eight Years in Dhulikhel Hospital.
Introduction: One of the greatest achievements in the surgical field is the paradigm shift from open surgery to minimal invasive surgery. Hysteroscopy, laparoscopy, laparoscopy-assisted vaginal hysterectomy and total laparoscopic hysterectomy are frequently performed minimal invasive gynecological surgeries. These surgeries are being regularly performed in Dhulikhel hospital. This study aims to review the changes in surgical approaches in the field of gynecological surgeries in this institute. Methods: This was a retrospective study of changes in surgical approaches from conventional to minimal invasive surgery in the field of gynecological surgeries from 2010 to 2018. Demographic characteristics of patients and indication for various minimal invasive surgeries were compared over this time period. Results: There were significant changes in surgical approaches from conventional open surgeries to minimally invasive approach through the years. There was no obvious difference in demographic characteristics of the cases and the indications for hysterectomy and endometrial sampling were comparable. Conclusion: There was definitely paradigm shift in conventional method to minimal invasive methods for major gynecological surgeries like hysterectomy, ovarian cystectomy, salpingectomy for ectopic pregnancy and endometrial samplings.
Prevalence and Associated Risk Factors of Hypertension Among Adults in Palpa District, Nepal
Introduction: Hypertension mostly remains asymptomatic when controlled, however, there is always an increased risk of heart disease, stroke, and renal failure. The higher the blood pressure, the higher the likelihood of harmful consequences to the heart, blood vessels, eyes, brain, and kidneys. Methods: A community-based cross-sectional study was conducted in the adult population. The blood pressure was measured from the left arm, the respondents in sitting posture and arm support at the heart level. Results: The prevalence of hypertension was 22% and higher in people above 60 years of age. The prevalence of hypertension was more in people who had elevated waist to hip ratio (65%) and positive family history (40.8%). The prevalence of hypertension was observed high among diabetics (63.2%) and in smokers (33.3%). Conclusion: The prevalence of hypertension was seen positively associated with increasing age, smoking, alcohol sedentary lifestyle, diabetes, stress, central obesity and >25 BMI.
Variations of Nutrient Foramen of Femur and its Clinical Implications
Introduction: Nutrient foramen is the largest opening on the shaft of the femur that conveys nutrient artery into the marrow cavity. Knowledge on locations of nutrient foramina is essential during surgical procedures as well as to rule out if the fracture line passes through the foramina. The purpose of the study was to determine the number and position of nutrient foramina in relation to length and topography of the femur. Methods: The study model was descriptive, cross-sectional study that included 151 femurs (71 right and 80 left side). The total number, location, and direction of nutrient foramina were investigated. Total length of femur and distance of foramen from the proximal end was measured with the 500mm 20" Digital Vernier Nib Jaw Caliper Metric/ Imperial Machine-DRO and finally Foraminal Index was calculated. Results: The analysis revealed 119(78.81%) of the femurs with single nutrient foramen, 31(20.52%) with double and 1(0.67%) with triple nutrient foramina. Foraminal Index II was found in 74(86.05%) on right side and 90(91.84%) on left side. The most common location of nutrient foramen was the medial lip of linea aspera (n= 77, 41.85%). All of the foramina were directed towards the proximal end. Conclusion: The present study has reported the majority of nutrient foramina located in the middle third of femur along the linea aspera. Thus, linea aspera should not be stripped off during surgical procedures to avoid damage to the nutrient arteries.
Copyright (c) 2019 Dr Pragya Shrestha, Dr Dil Islam Mansur, Mr Dilip Kumar Mehta, Dr Sheprala Shrestha, Ms Anupama Shrestha
Otomycosis and its Predisposing Factors in Out-Patient Department of Otorhinolaryngology in a Tertiary Care Center
Introduction: Otomycosis is a fungal infection of external auditory canal frequently encountered by otorhinolaryngologists. It causes discomfort to patients with varied symptoms of pruritus, otorrhea, aural fullness and earache. People with a habit of using unnecessary ear drops, cleaning ear with unsterilized objects and those who use mustard oil are all prone to otomycosis. This study aims to find out the association between otomycosis and its predisposing factors. Methods: This study was undertaken in the Department of Otorhinolaryngology of a tertiary hospital from March 2018 to February 2019 and a total of 300 clinically diagnosed cases of otomycosis were enrolled for the study. Results: The mean age ±SD of the patients was 37.7 ± 18.8 years. Females (n=172, 57.3%) were more prone to otomycosis than males (n=128, 42.7%). The most common presenting symptom was pruritus only (n=95, 31.7%) with unilateral involvement being more common. The most common predisposing factor was mustard oil instillation (n=124, 41.3%). Aspergillus niger was the most common fungus causing otomycosis in this study (n=104, 34.7%). Positive fungal cultures were observed in 285 specimens (95%). The fungal growth (n=285) was high in patients with the history of instilling mustard oil (42.8%) into the ear, 34.0% in topical steroid containing ear drops and 23.2% in self-cleaning group. Conclusion: Otomycosis is common in people using unnecessary steroid containing ear drops, cleaning ear with unsterilized objects and instillation of mustard oil.
Efficacy of Tranexamic Acid in Reducing Blood Loss in Cesarean Section: A Comparative Study.
Introduction: Obstetric hemorrhage is one of the major causes of maternal morbidity and mortality. Blood loss during cesarean section is almost twice than that in vaginal delivery. The aim of this study was to evaluate the efficacy of tranexamic acid to reduce blood loss in cesarean section and its side effects. Methods: A comparative study was done in 100 women undergoing cesarean section between December 2015 to January 2017. The study group of 50 women received one gram intravenous tranexamic acid and the control group of 50 women did not receive tranexamic acid. Primary outcome measure was blood loss during cesarean section. Secondary outcome measures were drop in post-operative hemoglobin and hematocrit, change in pulse rate and blood pressure, need of additional uterotonics, auxiliary procedures to stop bleeding, blood transfusion rate and maternal and neonatal side effects of the drug. Results: Mean intraoperative blood loss in the study group was 443.62± 86.73ml; and in control group, 667.40±131.01ml (p<0.001). Mean postoperative drop in hemoglobin (g/dl) in the two groups were 0.82±0.27 and 1.86±0.64 respectively (p<0.001). Mean postoperative drop in hematocrit in the two groups were 2.60±0.91 and 5.49±1.97 respectively (p<0.001). Fourteen patients in the control group required additional uterotonics while none in the study group (p<0.001). There was no significant difference in the transfusion requirement (p=0.079). None of the mothers and the newborns had major side effects of drug. Conclusion: Tranexamic acid is a safe and effective drug to reduce blood loss in cesarean section.
Perceived Barriers to Adherence to Standard Precautions among Healthcare Personnel Working in a Teaching Hospital of Palpa District, Nepal
Introduction: The present study aimed to find out the perceived barriers to adherence to standard precautions among healthcare personnel working in a teaching hospital of Palpa district. Methods: A descriptive cross-sectional study was conducted among 191 healthcare personnel in April 2019. Barriers to standard precautions adherence were evaluated using ‘Factors Influencing Adherence to Standard Precautions Scale’. Mann Whitney U test and Kruskal Wallis H test were applied to examine the association of selected demographic variables: age, educational background, duration of employment, working areas and having attended trainings related to standard precautions with the perceived barriers to standard precautions adherence. Results: The mean age of participants was 24.87±6.05 years. Most (85.3%) of participants were nurses. 19.9% and 52.4% of participants always performed hand hygiene before and after using personal protective equipment respectively. The subscale scores in leadership and culture of the institute were 14.86±4.21 (possible range 0-24) and 14.59±2.60 (possible range 0-20) respectively. Subscale scores in judgement and contextual cues were 17.49±3.46 (possible range 0-20) and 18.02±5 (possible range 0-24) respectively. Score in justification was 7.52±5.12 (possible range 0-28). Age, educational background and duration of employment had a statistically significant association with subscale scores on justification and perceived culture of the institution. Conclusion: The present study revealed that only 19.9% of the participants would perform hand hygiene before using gloves and 52.4% of participants would do it afterwards. Personal judgement, dependence on contextual cues and inadequate leadership skills were found to be the major barriers to adherence to standard precautions.
Copyright (c) 2020 Chandra Kumari Garbuja
Risk Factors for Obesity in Nepalese Women: A Cross-sectional Study
Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. It is on the rise worldwide, not sparing developing countries. Both demographic and socioeconomic factors play an important part in its causation. Body mass index is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. This study was done with objectives of assessing the prevalence of overweight and obesity and its associated factors among adult women attending selected outpatient departments of tertiary care center in western region of Nepal. Methods: A descriptive cross-sectionalthe study was conducted for six months. A total of 160 female respondents aged more than 20 years attending outpatient departments were included in the study using non-probability convenient sampling technique. Data on socio-demographic status, dietary pattern, health risk behavior and presence of chronic illness were collected and anthropometric measurements were taken for all the respondents. Results: The prevalence of overweight and obesity were 31.8% and 3.8% respectively. There was a statistically significant association between obesity and overweight with age (p=0.044), educational status (p=0.017), frequency of consumption of fruits (p=0.029), dietary pattern (p=0.023), frequency of consumption of dairy products (p=0.019), marital status (p=0.020) and drinking alcohol (p=0.022). Conclusion: Age, educational status, frequency of consumption of dairy products, dietary habits, marital status and drinking habits were strongly associated with obesity and overweight among adult women.
Role of Ultrasound Scan in Non-Traumatic Acute Abdomen Presenting in Surgery Department of a Tertiary Care Center
Introduction: An acute abdomen is defined as a clinical condition characterized by severe abdominal pain developing suddenly over several hours or less. Ultrasonography (USG) helps the managing surgeons arrive at early diagnosis and rule out alternative diseases, thus reducing negative laparotomy rate. This study analyzed the diagnostic yield of USG in patients with non-traumatic acute abdomen presenting to Surgery department via Emergency department/outpatient department of a tertiary hospital. Methods: This cross-sectional observational study included 110 patients with non-traumatic acute abdominal pain who were sent for USG examination. The percentage concordance of USG diagnosis with the final diagnosis at discharge was determined in terms of sensitivity, specificity, positive and negative predictive values for acute abdomen. Results: Of 110 patients, correct clinical diagnosis was made in 83 patients (75%) while USG made a correct diagnosis in 101 patients (91%). Hence, with the help of USG, accuracy of diagnosing cause of acute abdomen increased by 16 %. The sensitivity and specificity of USG in diagnosis of acute appendicitis were 87.7% and 98.3% respectively. Conclusion: USG is easily available and non-invasive modality without radiation exposure and requiring minimal patient preparation. USG should, therefore, be an important routine diagnostic investigation in patients presenting with acute abdomen.
Apical Hypertrophic Cardiomyopathy: A Special Entity.
Introduction: Apical Hypertrophic Cardiomyopathy (AHCM) is a unique variant with distinct clinical presentation, genetics, treatment, complications and outcome. Case: A 52 year non-hypertensive Asian male presented with exertional shortness of breath for two years without chest pain, palpitation or syncope. The apex beat was heaving. Electrocardiogram revealed non q wave deep symmetrical T wave inversion in anterolateral leads and echocardiography demonstrated hypertrophied apical septum. Coronary angiogram showed normal coronaries with typical “Ace of Spadeâ€ configuration during ventriculography. Conclusion: Characterization of various forms of hypertrophic cardiomyopathy is essential for management purpose as apical hypertrophic cardiomyopathy usually have benign course.
Clinico-epidemiology of Hymenoptera Stings in and around Kaski District, Nepal.
Introduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three commonly encountered insects: hornets (local: aringal), wasps (local: barulo) and honey bees (local: mahuri). The present study documents the incidence of hymenoptera sting in Western Region of Nepal and explores the cause behind such unprovoked attack upon human subjects. Methods: This hospital-based study included all the patients with history of insect sting attending the Emergency Department of Manipal Teaching Hospital, Pokhara from May 2015 till November 2015. Results: Of total 16 cases during the study period three were brought dead cases. The alleged insect happened to be bee in two cases, hornet in two cases, and wasp in eight cases with a case of unidentified insect sting. Severe burning pain with swelling, redness and itching were the common presenting symptom in all the admitted patients (n=13). Conclusion: Agricultural activity during the day was the cause of most unprovoked stings followed by deliberate destruction of the insect hive. Immediate medical attention in the nearby health care facility to the victims will save mortality. The health care facility also needs to have surplus lifesaving medication to counteract the life-threatening anaphylaxis reactions from such stings.
Drug Utilization Pattern for Conjunctivitis in a Tertiary Care Hospital
Introduction: Assessment of drug utilization pattern of conjunctivitis is an important activity that promotes the rationale use of drugs. Thus, the aim of the study is to understand the drug use pattern for conjunctivitis in a tertiary care hospital. Methods: A cross-sectional observational study was conducted in the out-patient department of Ophthalmology of Nobel Medical College Teaching Hospital from October 2021 to September 2022. Patients diagnosed with conjunctivitis irrespective of age and gender were included in the study. A structured proforma was designed that contained the demographic profile of participants, types of conjunctivitis and different drugs used in conjunctivitis. Data were expressed in frequency and percentage. Results: A total of 385 patients were enrolled in the study. Conjunctivitis was more common in male (55.8%). Viral conjunctivitis was the most common (49.8%). A total of 745 drugs were used. Average number of drugs per prescription was 1.9. The most commonly prescribed drugs were topical antibiotics (40.9%) followed by tear drops (27.5%). Ciprofloxacin (36.1%) was the most commonly prescribed topical antibiotic. Conclusions: Topical antibiotics were commonly used in most cases of conjunctivitis. Among topical antibiotics, ciprofloxacin was commonly prescribed.
Study of Neck Circumference as a New Anthropometric Indicator for Prediction of Diabetes Mellitus
Introduction: Overweight and obesity are the risk factors for metabolic syndrome. This study aimed to show that neck circumference is a simple tool to identify the overweight and obesity as a new anthropometric index and association with type 2 diabetes. Methods: This was a cross-sectional study with a total of 246 participants, 123 of whom had diabetes mellitus, and the same numbers were non-diabetics, adjusted for weight and height in both groups. Means with standard deviation were used for neck and waist circumferences, body mass index, and blood sugar, and the Pearson correlation test was applied to identify the association. A comparison of means was done by the student ‘t' test in parametric data within the two groups. Results: The mean neck circumference, body mass index of diabetes and non-diabetes participants were 38.0±3.0 cm, 28.5±2.6 and 36.6±3.2 kg/m2, 27.4±3.1 kg/m2 respectively. In diabetic patients, mean neck and waist circumference, blood sugar were higher than in nondiabetic patients and was significantly correlated with body mass index (r=0.747, p<0.001), waist circumference (r=0.635, p<0.001), systolic and diastolic blood pressure (r=0.740, p<0.001 and r=0.619, p<0.001 respectively), fasting and post prandial blood sugar (r=0.275, p=0.002 and r=0.307, p<0.001respectively) and glycated hemoglobin (r=0.220, p=0.014, n=123). In nondiabetic patients, glycated hemoglobin was negatively correlated. Conclusion: This study suggested that neck circumference is a simple, reliable, and appropriate new anthropometric tool to evaluate obesity, overweight, and the risk of metabolic disorders.
Predictive Factors for Post-Operative Bleeding in Percutaneous Nephrolithotomy.
Introduction: Post-operative bleeding is a serious complication necessitating prompt attention in Percutaneous Nephrolithotomy (PCNL). A number of factors dictate the severity of post-PCNL bleeding. Identification of these risk factors helps prevent bleeding complications. Methods: In this observational cross-sectional study, a total of 126 patients with renal stones >10mm or stag-horn stones underwent PCNL. All the relevant pre- and intra-operative factors were noted and analyzed. Hemoglobin differences between pre- and post-operative levels were considered for the evaluation of blood loss. Univariate and multivariable logistic regression analysis was done. The strength of association was examined using Odds Ratio and 95% confidence intervals derived from the logistic regression. A p value <0.05 was considered statistically significant. Results: The mean age of the patients was 31.9 ±4.47 years. The mean drop in hemoglobin was 1.83 ±0.98 gm/dl. Age, stone size, number of tracts, size of Amplatz sheath and number of stones significantly affected the blood loss in univariate analysis. Among the variables mentioned above only, the number of stones could maintain the significance in multivariable analysis (p<0.05). The number of stones increase the risk of bleeding post PCNL by 4.4 times. Conclusion: Stone size, number of tracts, size of Amplatz sheath and the number of stones significantly affect the blood loss post PCNL. Identification of these risk factors should be considered for minimizing bleeding in PCNL.
Copyright (c) 2019 Neeraj Thapa, Suman Baral, Raj Kumar Chhetri, Santosh Paudel
Correlation between C - Reactive Protein and Blood Culture in Neonatal Sepsis at a Tertiary Care Centre in Western Nepal
Introduction: Neonatal sepsis is a serious problem that needs to be addressed for a better outcome of the neonates. This study was conducted to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of C-Reactive Protein (CRP) in neonates with sepsis in comparison with blood culture. Methods: This cross-sectional study was carried out in clinically suspected neonates with sepsis in a tertiary hospital. Association between C-reactive protein and blood culture positivity in neonatal sepsis was studied. Results: Out of 245 patients admitted with clinical suspicion of sepsis, 104 (42.45%, 95% CI: 36.18-48.90%) were blood culture-proven sepsis. CRP was reactive in 92 cases (88.5%, 95% CI: 80.71 % - 93.89%) of blood culture-proven sepsis. Gram-negative organisms were predominant, 58 (57.55%) seen from the isolates of blood culture while gram-positive organisms were found to be 46 (43.23%). Early-onset sepsis was seen in 194 (79.18%) cases, while late-onset sepsis accounted for 51(20.82%). The sensitivity and specificity of CRP in the diagnosis of neonatal sepsis was 88.5% and 46.1% respectively with the positive predictive value of 54.8% and negative predictive value of 84.1% and diagnostic accuracy of 64.1%. Conclusion: Neonatal sepsis is still an important cause of hospital admission in the neonatal intensive care unit of our hospital. This study highlights the high sensitivity and negative predictive value but lower specificity and positive predictive value of CRP in relation to blood culture. The present study depicts a significant correlation between culture positivity and CRP.
Burden Imposed by Diabetes Mellitus on Elderly Patients Visiting a Teaching Hospital: A Cross-sectional Study
Introduction: Diabetes Mellitus, a chronic metabolic disorder, has become an alarmingly major health issue worldwide. This study aimed to assess the burden imposed by diabetes mellitus on elderly patients visiting Lumbini Medical College and Teaching Hospital. Methods: A descriptive cross-sectional study was conducted purposively among 178 diabetic elderly patients visiting medicine out-patient department of Lumbini Medical College. The Elderly Diabetes Burden Scale was used to assess the burden imposed by diabetes. Results: The mean (SD) age of the participants was 67.38 (6.92) years, more than half (52.2%) were male, 46.6% were Janajati and 77.5% were from Palpa district. Most (84.3%) had diabetes for duration of one to 10 years, 45.6% had normal body mass index, 47.2% had good glycemic control (HbA1C <7%), and 74.2% were on oral hypo-glycemic agents. Dietary restrictions (10.32±2.97) and worry about diabetes (10.30±2.85) had imposed high burden level and burden by tablets/insulin (7.02±2.12) as lower burden amongst the six domains. Age, education and body mass index were found to be statistically significant with the treatment dissatisfaction domain (p=<0.001). Likewise, duration of diabetes (p=<0.001) was statistically significant with burden by tablets/insulin and symptom burden domain. Conclusion: Dietary restrictions and worry about diabetes were found to have dominant burden whereas, burden by tablets or insulin was the least. Duration of diabetes and body mass index were found to have association with the overall burden. Likewise, age, education and body mass index had high influence on the perceived burden due to treatment dissatisfaction.
Copyright (c) 2023 chandra kumari garbuja, Geeta Rai, Binita Ranamagar
Ocular Manifestations in Patients with Extrapulmonary Tuberculosis
Introduction : The study was done to find out the ocular manifestation in patients with extrapulmonary tuberculosis visiting a tertiary eye centre. Methods: A hospital based descriptive observational study was done among newly diagnosed extrapulmonary tuberculosis cases after approval from the institutional review board. After a detailed ocular evaluation, findings including patient demographics, presenting complaints, best corrected visual acuity, colour vision, contrast sensitivity, Goldman visual field and Optical Coherence tomography Retinal nerve fibre layer analysis of the optic nerve head were recorded in a semi-structured proforma. Data were expressed in frequency and percentage. Results: Out of 50 eyes of 25 patients included in the study, the mean age was 26.92±14.2 years (11-73 years). Sixty four percent were female. Two cases had ocular findings at the time of diagnosis. One case of tuberculous lymphadenitis had phlyctenular conjunctivitis and one case of tubercular meningitis had diplopia with right lateral rectus muscle paresis secondary to raised intracranial pressure. All the patients had best corrected visual acuity better than 6/12 at presentation. Color vision was normal in 72% cases in both eyes. Goldman visual field done at presentation were normal in both eyes in 88% cases while retinal nerve fibre layer thickness and contrast sensitivity were normal in all cases. Conclusion: The prevalence of ocular findings in patients with extrapulmonary tuberculosis was 8% in this study. Ocular examination is important in cases with extrapulmonary tuberculosis since a significant number of cases have ocular findings.
Copyright (c) 2023 Sanjeeta Sitaula, Ranju Kharel Sitaula, Shilu Thapa, Sameer Chapagain, Hira Dahal
Evaluation of Intra-operative and Post-operative Complications of Non Descent Vaginal Hysterectomy: A Single-center Hospital-based Prospective Study
Introduction: Globally, hysterectomy is the most common major gynecological procedure. Patients opting for hysterectomy for benign non-prolapse cases may be offered non-descent vaginal hysterectomy with quicker recovery, shorter hospital stay, and less intra- and post-operative morbidity compared to the abdominal route. Vaginal approach for hysterectomy is desirable in Nepal due to limited health resources. This study aimed to evaluate the intra- and post-operative complications of non-descent vaginal hysterectomy (NDVH). Methods: A prospective study was conducted at College of Medical Sciences over one-year period. A total of 50 cases were selected for NDVH on the basis of inclusion and exclusion criteria. Data regarding age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded. Results: The majority of women were in the age group of 41-45 years (mean age: 44.7±5.6 years) and multiparous (38%). The common indications for NDVH were fibroid uterus (66%) and adenomyosis (14%). The mean volume of blood loss was 121.5ml±110.94 and 3% required blood transfusion. The mean drop in hemoglobin level was statistically significant post surgery [1.05gm/dl]. The mean surgical time was 69.54±19.32 minutes. In the post-operative period, 10% women had UTI and 2% had fever. The mean duration of hospital stay was 4.06±0.24 days. Conclusion: Non-descent vaginal hysterectomy is a major surgery suitable in low-and middle income countries like Nepal with good outcomes and low complication rates.
Copyright (c) 2023 Buddhi Shrestha, Satindar Ray
A Students’ Perception in Learning Human Anatomy Towards Dissection or Prosection
Introduction: Cadaveric dissection has been used as a traditional method of teaching and learning for many years. With time, changes in the medical curriculum have reduced the time for anatomy learning and seeking alternative methodologies moving away from traditional learning. With the introduction of new methodology and technology, the question arises whether it is still effective enough to follow the old traditional mode of teaching and learning. With ever-changing medical education, it is important to recognize students' perceptive and attitudes toward learning different methods. Therefore, this study aimed to determine students’ perception towards prosection and dissection in learning anatomy. Methods: The first-year medical students were included in the study. The study was carried out after a series of lectures as per the curriculum. The students were divided into four groups. Each group dissected the cadaver followed by observation of the prosected cadaver explained by the faculty. Questionnaires were prepared related to dissection and prosection and sent to the students using google form. The students' perception towards dissection and prosection was recorded. The results were tabulated and subjected to statistical analysis. The percentage of students opting for dissection and prosection was calculated. Results: The majority of students (82.5%) preferred dissection over prosection, 2.6% opted for prosection over dissection and 14.9% were still not sure which method of teaching and learning is favorable. Conclusion: The study reflected the traditional method of dissection was more favorable to students while alternative methods can also provide better insight to learning.
Endoscopic Transcanal Type I Cartilage Tympanoplasty for Anterior Perforation of Tympanic Membrane: A Cross-sectional Study
Introduction: Repair of anterior perforation of the tympanic membrane is difficult mainly due to inadequate exposure, minimal tympanic membrane remnant, impaired vascular supply, and delayed healing. Methods: This analytical cross-sectional study was done in a tertiary center over a period of 12 months from 25 April 2021 to 24 April 2022. There were 47 patients who underwent endoscopic transcanal type I cartilage tympanoplasty for anterior perforation. All operations were performed using an underlay technique and by transcanal approach. In all the cases, perichondrium with tragal cartilage was used as a graft for the reconstruction of the tympanic membrane. The evaluation was done after three months post-operatively in terms of graft uptake and post-operative hearing status. Results: The overall graft uptake success rate after three months post-operatively was 89.4%. The pre-operative mean pure-tone average was 34.72 ± 6.45 dB, (range 17 dB to 43 dB). The mean postoperative pure-tone average was 22.09 dB ± 9.30 (range 10 to 41 dB). The mean difference between the preoperative pure tone average and the postoperative pure tone average was 12.63 dB ± 8.96 (p < 0.05). The mean preoperative air-bone gap average was 23.38 dB ±7.98 (range 6 to 40 dB) and the mean postoperative air-bone gap of 13.45 ± 6.89 (range 5 to 32 dB). This resulted in improvement in the air-bone gap by 9.93 dB (p < 0.05). Conclusion: Endoscopic transcanal tympanoplasty is a minimally invasive procedure, which provides complete exposure of anterior tympanic membrane perforation thus avoiding external incisions and canaloplasty.
Satisfaction of Online Learning among Nursing Students during COVID-19 Pandemic in Pokhara
Introduction: The outbreak of COVID-19 pandemic across the world has profoundly altered almost all aspects of life, including education. Conducting online learning was necessary to continue academic activities across all schools worldwide. The objective of this study was to assess satisfaction of online learning among nursing students. Methods: A descriptive cross-sectional study was carried out among 191 nursing students of PCL and B.Sc nursing programme. An enumerative sampling technique was used to select the sample. The self-administered web based questionnaire was used to collect data. The collected data was analysed by using descriptive and inferential statistics. Results: More than half (56%) of students were satisfied with online learning. A majority (95.8%) agreed that they need to be updated with the latest technology, 93.2% agreed on self-discipline is necessary during online class, 78% students agreed that they feel practical/clinical simulation exercises through online class is difficult, and 73.3% agreed the instructors organization and preparation for class provides comfortable online learning environment. However, only 23.56% of them agreed that they feel lazy and disinterested during online classes. There was significant association between level of satisfaction and type of residence, monthly family income, and academic level. Conclusion: More than half students are satisfied in online learning. Students' satisfaction is one of important factors for effective outcome from online learning. So, E-learning is a good opportunity to continue education in future.
Copyright (c) 2022 Man Maya Rana, Sandhya Shrestha
Risk Factors Associated with Frozen Shoulder among Nepalese Population: A Hospital-based Comparative Study
Introduction: Frozen shoulder is one of the common musculoskeletal disorders characterized by pain and restriction of motion of the shoulder joint. It is also considered a common self-limiting regional skeletal problem. This study aimed to evaluate related risk factors for frozen shoulders. Methods: This was a hospital-based comparative study involving 60 patients with a diagnosed frozen shoulder in the out-patient department as cases and 60 patients hospitalized during the same period with non-shoulder-related complaints as controls. A face-to-face interview was taken. Univariate and multivariate logistic regression analyses were performed. Results: A total of 120 consecutive subjects (60 patients with frozen shoulders and 60 controls) were taken. The mean age of cases was 54.7±3.21 years and that of controls was 42.08±2.74 years. Among the frozen shoulder patients, 33.3% had diabetes and 15% had a history of thyroid disorder. Multivariate logistic regression analysis showed age, diabetes mellitus, and thyroid dysfunction as independent risk factors for frozen shoulder (p<0.05). The frozen shoulder patients also had a higher prevalence of cardiac diseases and cervical spondylosis than the controls. No significant difference was found in body mass index, cholecystitis, history of surgical intervention, and uric acid level between the frozen shoulder group and the control group. Conclusions: The study findings indicated that diabetes, thyroid disease, and advanced age have been significantly associated with increased frozen shoulders.
Copyright (c) 2023 Dipendra Singh Chhetri
Prevalence of Abnormal PAP Smear in Pregnancy: A Hospital-Based Study in Western Nepal
Introduction: Cervical carcinoma is the third most common malignancy worldwide. The World Health Organization in 2014 reported the crude incidence rate of cervical cancer in Nepal as 24.2 per 100,000 women per year. This study was carried out with the aim of finding out the prevalence of cervical smear abnormality in pregnancy. Methods: An observational study was conducted in the department of Obstetrics and Gynecology of a tertiary center for a period of one year from May 2021 to April 2022. All pregnant women up to 28 weeks of gestation who had National Health Insurance coming for antenatal check-ups underwent PAP smear test. The cytological results were reported based on the Bethesda classification system 2001. Results: Of 200 pregnant women enrolled in the study, the Pap smear report revealed that 32% of the study subjects had inflammatory smear showing candidiasis and bacterial vaginosis with reactive inflammatory changes. However, 66.5% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.5% of subjects had signs related to carcinoma cervix in which the subject had a low-grade squamous intraepithelial lesion. No satisfactory sample was reported in 1% of the subjects. Conclusion: Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.
Peripheral Neuropathy and Foot Care Practices Among Patients with Diabetes Mellitus Attending a Tertiary Care Hospital: A Cross-sectional Study
Introduction: Peripheral neuropathy is the most common microvascular complication of diabetes mellitus. Foot care is an important part of diabetes management. This study aimed to identify the prevalence of peripheral neuropathy and foot care practices among diabetic patients. Methods: A descriptive cross-sectional study was conducted on 178 patients diagnosed with diabetes mellitus and attending out-patient and in-patient departments of Internal Medicine at Kathmandu University Hospital, Dhulikhel. The participants were conveniently selected. Face-to-face interviews and a foot examination were used to collect data. The Michigan Neuropathy Screening Instrument and the Nottingham Assessment of Functional Foot Care were used to determine the prevalence of peripheral neuropathy and to assess foot care practices. Results: The prevalence of peripheral neuropathy was 41% among the participants, and it was associated with increasing age. The majority (75.8%) of the participants had good foot care practices. Male gender was significantly associated with good foot care practices [AOR = 5.973, 95% CI (2.037-17.515)], whereas past smokers [AOR = 0.296, 95% CI (0.111-0.791)] and not receiving diabetes education [AOR = 0.367, 95% CI (0.151-0.892)] were significantly associated with poor foot care practices. Conclusion: The prevalence of peripheral neuropathy was found to be high, and it was linked to an increased age group. The majority of the participants had good foot care practices. However, in comparison, females were found less likely to practice foot care than males.
Copyright (c) 2023 Radha Pandey, Samridhi Chauhan, Jyotsna Pandey, Ashmita Chaudhary, Chandranshu Pandey
Antihypertensive Drug Use Pattern in a Tertiary Care Hospital of Western Region of Nepal: A Cross-Sectional Study
Introduction: Assessing antihypertensive drug use pattern always plays an important role to mitigate the burden of hypertension and also helps doctors to prescribe the drugs rationally. This study was conducted to assess antihypertensive drug use pattern in a tertiary care hospital. Methods: An observational cross-sectional study was conducted in the Internal Medicine department of Lumbini Medical College and Teaching Hospital from July 2021 to December 2021 for the duration of five months after ethics approval. Hypertensive patients who were prescribed one or more antihypertensive drugs irrespective of age and gender were included. Socio-demographic profiles, clinical characteristics, and antihypertensive drug use-related data were collected. A convenience sampling technique was used. Categorical variables were expressed as frequency and percentage while continuous variables were reported as mean Â± standard deviation. Results: A total of 224 patients were included. The average number of antihypertensive drugs per patient was 1.7 ± 0.8. Combination drug therapy (54.5%) was commonly used. Calcium channel blockers (Amlodipine) were commonly prescribed (66.5%). Moreover, 98.7% and 41.5% patients were prescribed drugs from Essential Drug List of Nepal (Revised 2016) and in Fixed Dose Combination respectively. Use of combination drug therapy was higher among male patients (p = 0.003) and patients with stage II hypertension (p < 0.001). Conclusion: Calcium channel blockers were commonly used as monotherapy and in combination therapy as well. In approximately all of the patients, antihypertensive drugs were used from the essential drug list of Nepal which is an essential component of rational use of medicine.
PAP Smear versus Colposcopy in the Absence of HPV-DNA Testing for the Screening of Pre-malignant and Malignant Cervical Lesions
Introduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions. Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment.
Screen Time in Children of Central Nepal: A Parent Reported Cross-sectional Study during COVID-19 Pandemic
Introduction: The insurgence of COVID-19 has affected many aspects of human life and its repercussions on the life of children cannot be undermined. In addition to the serious impact on health and food insecurity, lack of recreational activities, school closure and switch to online learning have pushed children to excessive screen exposure. This study aimed to assess the duration of screen time and parental perspective towards screen viewing in children during the pandemic. Methods: A community-based descriptive cross-sectional study was carried out in Bharatpur Metropolitan City. A total of 384 parents were included purposively. A semi-structured questionnaire was used to interview the parents during the pandemic for one month. During the data collection, appropriate universal precautions for COVID-19 were taken. Results: The median duration of screen exposure was two hours (30 minutes to 9 hours). Most (65%) of the parents stated that their children spent more time on screen compared to pre-COVID-19 times. The majority (82%) of the parents were worried about the possible consequences of excessive screen time. More than two-thirds (72%) of parents thought that screen exposure also has various benefits for children. Conclusion: Most of the children exceeded the duration of screen time recommended by the World Health Organization. Most of the parents were worried about the harmful effects on the health and behavior of children.