Journal of Universal College of Medical Sciences

The Art of Skill Transfer

Santosh Shah — Sun, 31 Dec 2023 00:00:00 +0000

In today's dynamic world, the ability to transfer skills across various domains has become a cornerstone of personal and professional success. As industries evolve and technology advances, individuals who master the art of skill transfer find themselves not only adaptable but also at the forefront of innovation.

A Critical Study of Attitudes of MBBS and BDS Students Towards Their Future Profession

Wed, 01 Nov 2023 00:00:00 +0000

INTRODUCTION The attitudes of the students play a very vital role in choosing a particular career. The amount of study in MBBS and BDS is signiﬁcantly higher than many other professions. Hence the present study was designed to assess and explore the attitudes of MBBS and BDS students towards their future medical profession.

MATERIAL AND METHODS A descriptive, cross-sectional study was conducted by administering online Google Form questionnaire to all MBBS and BDS students (1st year to 4th year) Universal College of Medical Sciences, and College of Dental Surgery, Bhairahawa, Nepal, during the period of 1 October, 2020 to 30 December, 2020, using non-probability purposive sampling. The sample size of the present study is 283 (198 MBBS and 85 BDS). The questionnaire was consisting of 32 statements, both positive as well as negative (Likert scale), on 5 options via strongly disagree, disagree, neutral, agree and strongly agree, was mailed to all students. The students were asked to read each statement carefully and click on their opinion/response.

RESULTS The overall mean and standard deviation for MBBS students’ attitude towards their medical profession was 3.73 and 0.87 respec- tively. Similarly, the overall mean and standard deviation for attitude of BDS students’ towards their future profession was 1.60 and 0.37 respectively.

CONCLUSION Both MBBS and BDS students were having a positive and right attitude towards their future medical profession.

Pre-operative Predictive Factors for Difficult Laparoscopic Cholecystectomy at Tertiary Care Centre

Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Gallstones are present in 10 to 15% of general population and asymptomatic in more than 80% cases. Laparoscopic cholecystectomy is a gold standard treatment for cholelithiasis. The rate of conversion from laparoscopic cholecystectomy to open is about 1-13%. Predicting the difﬁculty of laparoscopic cholecystectomy is essential to optimize patient outcomes. The levels of difﬁculties during laparoscopic cholecystectomy can be predicated based on certain preoperative clinical, laboratory or radiological parameters. The main aim of the study was to ﬁnd out the pre-operative predictive factors for difﬁcult laparoscopic cholecystectomy at a tertiary care centre.

MATERIAL AND METHODS This was an observational cross-sectional study that included sixty nine patients who underwent elective laparoscopic cholecys- tectomy in UCMS. Preoperative predictive parameters such as age, gender, BMI, previous abdominal surgery, gallbladder condition, and ultrasound ﬁndings were assessed. A scoring system developed by Randhawa and Pujahari was used to predict difﬁculty in laparoscopic cholecystectomy, and intraoperative criteria were used to categorize cases as easy or difﬁcult.

RESULTS History of acute cholecystitis (p=0.026), previous abdominal scar (p=0.024), thick gallbladder wall (p=0.012), impacted stone (p=0.057), pericholecystic ﬂuid collection (p<0.001) and increased BMI were considered as the signiﬁcant factors that predict difﬁcult laparoscopic cholecystectomy. Sensitivity and speciﬁcity for easy - difﬁcult cut off of the scoring method were 75.6% and 67.16%, respectively, with the area under the ROC curve being 0.524.

CONCLUSION The difﬁcult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on preoperative scoring system.

Rheumatic Heart Disease In School Going Children: A Study From Lumbini Province, Nepal

Samir Gautam, Sachin Dhungel, Bishal KC, Mazhar Khan, Santosh Shah — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Rheumatic Heart Disease is declining from developed countries but still is important cause of morbidity and mortality in under- developed and developing countries.

MATERIAL AND METHODS It was a prospective observational study conducted at Lumbini Province Nepal. Seven thousand six hundred and fourty school going children were evaluated to look for presence of Rheumatic Heart Disease.

RESULTS Out of total 7640 school going children 56.6% were male and 43.4% were female. Majority (74%) of children evaluated belonged to Government school. Most of the children (54.7%) were of more than 10 years of age. Clinically murmur was present in 8.9%. RHD was found in total 14 children with prevalence of 1.83 per thousand children. RHD was more common in female (64%) than male (36%). Most common valve involvement was Mitral valve and most common lesion was Mitral Stenosis.

CONCLUSION RHD is still of major health concern among school going children in Lumbini Province Nepal. Strategies to reduce its occurrence in the community is important to reduce its complications.

Prevalence of Diabetes, Hypertension and Obesity among Doctors and Nurses in Universal College of Medical Sciences, Bhairahawa, Nepal

Sudhir Kumar Shah — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Hypertension (HTN) and diabetes mellitus (DM) both are rapidly emerging as public health problems in developing countries. Hypertension is the leading cause of cardiovascular disease and is also a major cause of disability, causing an estimated 13% of all deaths in the world. Diabetes mellitus, hypertension and obesity are very strongly associated with cardiovascular diseases all over the world.

MATERIAL AND METHODS A cross sectional study was done among the doctors and nurse working in UCMS teaching hospital from Sep, 2020 to Feb, 2021. A total of 138 doctors and nurses were selected using a simple random sampling technique. Descriptive statistical analysis was used for the calculation of central tendency and dispersion measures. Chi- Square test was applied for categorical predictors and P value of less than 0.05 was considered as statistically signiﬁcant.

RESULTS Doctors formed 47 % while nurses formed 53% of the study population. Prevalence of hypertension was found to be 18% among doctors and 7% among nurses. Prevalence of diabetes mellitus was found to be 6% among doctors and 8% among nurses. Prevalence of obesity was found to be 47% among doctors and 48% among nurses. The overall prevalence of hypertension, diabetes mellitus and obesity was the order of 25%, 14% and 95% respectively.

CONCLUSION These ﬁndings provide important information on prevalence of hypertension, diabetes mellitus and obesity along with its associ- ated risk factors among doctors and nurses working in UCMS teaching hospital. Preventive health measures like low fat diet, physical activity, cessation of smoking, control of alcohol and various strategies are needed for the prevention of these cardio-vascular disease among doctors and nurses working at UCMS teaching hospital.

Functional Outcomes of Open Reduction and Internal Fixation in Proximal Humerus Fractures by Philos Plate

Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Proximal humerus fractures are one very common and usually occur in elderly people. These fractures are usually associated with some degree of comminution and deformity. Therefore, good anatomical reduction of fracture fragments and early mobilization are the main component for optimal outcomes of involved limb. This study was intended to evaluate the functional outcome of proximal humerus fracture in adults managed by open reduction and internal ﬁxation (ORIF) by proximal humerus interlocking osteosynthesis (PHILOS) plate.

MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from October 2021 to September 2023. All patients with proximal humerus fractures who fulﬁlled the inclusion criteria and who underwent open reduction and internal ﬁxation by PHILOS plate were enrolled in the study. Functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months.

RESULTS In this study of 60 cases, the mean age group was 55.38±11.40 years and male patients outnumbered female patients (39 males and 21 females). 36 cases (60%) were of right side and 24 (40%) were of left side. Majority of the fractures were due to fall injury (57%) followed by road trafﬁc accident (35%). The mean Constant Murley Score was 78.15±5.620 and VAS (visual analogue score) was 1.88±0.865.

CONCLUSION Open reduction and internal ﬁxation by PHILOS plate is an effective procedure providing good anatomical restoration and early mobilization in proximal humerus fracture thus providing good functional outcome.

Utility of Supine Stress Test to Anticipate Spinal Anaesthesia Induced Hypotension in Patients Undergoing Elective Cesarean Section

Rejin Kumar Udaya, Deepanjali Sharma, Saba Khan, Laxmi Pathak, Pradip Chhetri — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Reduction in venous return caused by compression of the inferior vena cava by the gravid uterus, known as the supine hypotensive syndrome of pregnancy, is one of the reasons for particular susceptibility to hypotension at cesarean delivery. The hypotensive effect of spinal anaesthesia further exacerbates maternal hypotension in the supine position in term parturients. This study was conducted with the objective to evaluate the ability of supine stress test to predict spinal anaesthesia induced hypotension in patients undergoing elective cesarean section.

MATERIAL AND METHODS A prospective observational study was done among 232 singleton parturients scheduled for elective cesarean delivery under spinal anaesthesia in Universal College of Medical Sciences Teaching Hospital. Patients were subjected preoperatively to supine stress test and divided into two group of 116 patients each. SBP, DBP, MAP, HR were compared between two groups. Descriptive as well as inferential statistics were used to analyze the data.

RESULTS Supine stress test was positive by heart rate criteria in 50% of positive patient. The incidence of hypotension in positive test group was 73.3%, while it was 11.2% in negative test group, which was statistically signiﬁcant (p<0.001).

CONCLUSION This study demonstrates supine stress test preferably can easily identify parturients in risk of developing hypotension during cesarean section under spinal anaesthesia.

Diabetes Mellitus & Thyroid Dysfunction in Vitiligo of Terai Regions of Nepal

Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Vitiligo is common acquired disease. Clinically it present with depigmented, macules and patches. Vitiligo has been shown association with many autoimmune diseases like Diabetes mellitus, Thyroid disorders, Graves disease, pernicious anemia, etc. This study was undertaken to assess the prevalence and association of diabetes mellitus and thyroid dysfunction in vitiligo patient.

MATERIAL AND METHODS This study was a case control study carried out in Dermatology Department, Universal College of Medical Sciences – Teaching Hospital (UCMS-TH) from Dec 2022 to Nov 2023. 70 cases of Vitiligo and 70 control with same sex, ages and gender matched were enrolled. All patients in both the group, we performed thyroid function test and fasting blood sugar.

RESULTS Out of 70 cases, 6 (8.6%) people has impaired FBS and 6 (8.6%) people have high T3 & T4 and 10 (14.3%) people have high TSH whereas 3 (4.3%) people have low T3 & T4 and 4 (5.7%) people have low TSH. Association with different age group in both case and control group with fasting blood sugar and thyroid function test was seen which was statistically not signiﬁcant.

CONCLUSION There were impaired fasting blood sugar and abnormal thyroid dysfunction in many cases. Therefore vitiligo patient needs to undergo thyroid function test and blood sugar level to prevent the complication.

Pharmacological Evaluation of Cucumis Sativus Linn Fruits Extract For Anti Anxiety And Antidepressant Activity In Experimental Rats

Roshan Kuma Mehta, Sushan Shrestha, Vivek Kumar Mehta, Shankar Thapa — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Depression and anxiety are common mental health disorders, with a lifetime prevalence of 10% in the general population. Cucumis sativus mostly contain alkaloids, glycosides, terpenoids, ﬂavonoids, tannin used for its diabetic, purgative, skin disease, ulcer protective, laxative, anthelmintic effect. The present study was designed to extract the chemical constituents and evaluation of anti-anxiety and antidepressant activity of Cucumis sativus fruits using experimental rats.

MATERIAL AND METHODS The fruits of the Cucumis sativus plant were collected and chemical constituents were extracted by ethanol as solvent. Wistar rats of 150-250 gram were taken as study animal into four groups. Anti-anxiety and antidepressant activity were performed by Elevated plus maze and Forced swim test in Wistar rat. The ethanolic extract of low dose (250 mg/kg) and high dose (500 mg/kg) were subjected for anti-anxiety and antidepressant activity.

RESULTS

In the elevated plus maze as animal models of anxiety, extract treated 500 mg/kg showed more effective than 250 mg/kg in both time spent and number of entry in open arm but decrease in close arm as compared to control group (p<0.05). In forced swim test as an animal model of depression, extract treated 250 and 500 mg/kg produce signiﬁcant reduction (p<0.05 and p<0.001 respectively) in the immobility period. The extract 500 mg/kg was found to be similar to that of standard drug imipramine (p<0.001).

CONCLUSION The present study concludes that the extract possesses potent and sustained anti-anxiety and antidepressant activity of Cucumis sativus fruits.

Association of Quality of Root Canal Fillings and Coronal Restorations on the Periapical Status of Adult Population in Pokhara Academy of Health Sciences

Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION A cross-sectional study was done to determine the prevalence of apical periodontitis (AP) in root canal treated teeth in a selected population, and to evaluate the association of the quality of root canal ﬁllings and Coronal restorations (CR) on the Periapical status of root-ﬁlled teeth.

MATERIAL AND METHODS Total of 270 Orthopantomograms (OPGs) were evaluated. Out of which root canal treatment (RCT) had been performed in 400 teeth.

RESULTS Patients with inadequate root canal ﬁlling length (77.4%), density (76.1%) and coronal restoration (80.1%) had signiﬁcantly higher apical periodontitis seen than those with adequate root canal ﬁlling length (38.5%), density (48.1%) and coronal restoration (47.4%) (p<0.001, p<0.001, p<0.001 respectively).

CONCLUSION Our study revealed that combination of adequate CR, adequate density of root canal ﬁlling and adequate length of root ﬁlling resulted in signiﬁcantly reduced incidence of AP.

A Descriptive Cross-Sectional Study of Urinary Tract Abnormalities Utilizing Multi-Detector Computed Tomography Urography

Subhash Chandra Yadav, Sanju Rawal, Sadhan Mukhi, Darshana Dhakal — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Multidetector Computed Tomography Urography (MDCTU) is presently considered the preferred imaging modality for the urinary tract. Advanced MDCTU enables a comprehensive assessment of the kidneys, ureters, urinary bladder. MDCTU is commonly employed to investigate various conditions such as renal calculi, renal cysts, congenital kidney and ureter abnormali- ties, and speciﬁc renal inﬂammatory conditions. The objective of this study was to evaluate the diagnosis of various urinary tract abnormalities using MDCTU.

MATERIAL AND METHODS This descriptive cross-sectional study was conducted from June to August 2023, at the Department of Radiodiagnosis & Medical Imaging, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal, examined a total of ﬁfty-nine patients. The examination protocol comprised triphasic techniques, which included unenhanced, nephrographic, and excretory phases, utilizing a MDCT scanner. The descriptive data were analyzed using SPSS version 20 and presented in the form of a number and percentage.

RESULTS A total 59 patients, 32 were male and 27 were female. Mean age of patients were 44.17±15.66 years, with the majority (28.81%) falling within the age range of 20-30 years. Abdominal pain was the most common symptom (79.66%), followed by hematuria (18.64%). Urolithiasis was the most frequent diagnosis (47.46%), followed by ureterohydronephrosis (22.03%) and hydrone- phrosis (18.64%). Inﬂammatory change/infection affected 13.56% of patients, while congenital abnormalities were the least prevalent (3.39%).

CONCLUSION MDCT urography is considered the optimal modality for detecting a broad range of urinary tract abnormalities, due to its utilization of a combination of unenhanced, nephrographic-phase, and excretory-phase imaging techniques.

Evaluation of Prescription Errors in Teaching Hospital

Binaya Shrestha — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Prescription errors have been frequent problem in health care settings. Due to prescription error patients lose their faith towards healthcare providers. Therefore the study of prescription errors is necessary to promote rational use of medicine. The aim of the study was to assess the prescription errors found in the different wards of our institution.

MATERIAL AND METHODS A prospective observational study was conducted from June 2022 to January 2023 in a tertiary care teaching hospital in Kathmandu. Prescriptions of 350 patients admitted to the different wards of the hospital were included in the study after obtain ing ethical clearance from institutional review committee. A convenience sampling technique was used for collection of the data and the primary data were collected from the patient cardex and recorded in pre-designed proforma consisting of information about, diagnosis of disease and ﬁndings related to prescription errors. Data were entered in the MS excel and further analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 21.

RESULTS A total of 350 prescriptions belonging to patients admitted to the different wards were analyzed. Prescription errors were detect- ed in 86 prescriptions. Errors of omission were found in 19 prescriptions and 67 prescriptions showed error of commission. Among errors of commission drug interactions were most common.

CONCLUSION Nearly one fourth of prescriptions analyzed showed prescription error. Among them most common were errors of commission. Prevalence of drug interactions is signiﬁcant and needs to be monitored more promptly in our institution.

Assess the Psychological General Well-Being among Adolescent with Obesity in Selected Schools at Pokhara: A Descriptive Study

Nitu Kumari Singh, Indu Sah, Harikala Soti — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Childhood Obesity, is a serious medical condition that affects children and adolescents whose BMI at or above the 95th percen- tile for children and teens of the same age and sex. It is particularly troubling because the extra pounds often start children on the path to health problems. Childhood obesity associated with psychological problems such as anxiety and depression. Low self-esteem and lower self-reported quality of life. Social problems such as bullying and stigma. The aim of the study was to assess the level of psychological general well-being of adolescent with obesity and to ﬁnd out the association between the level of psychological general well-being and selected socio-demographic variables of adolescent with obesity.

MATERIAL AND METHODS A cross-sectional descriptive study was conducted in the Shishu Niketan and Triveni public schools of Pokhara, Nepal from 28/02/2023 to 27/03/2023 adolescents with BMI of 95th or more than 95th percentile was enrolled in the study from 10-19 age in years group after obtaining assent and consent from parents, child, and school authority.

RESULTS Out of 65 sample, 20% had moderate, 75% had good and only 4.6% had high level of psychological general well-being. Place of residence is signiﬁcant P=0.001.

CONCLUSION Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being which affects psycholog- ical well-being of children, leads to anxiety, low self-esteem. Schools play a large role in preventing childhood obesity by providing a safe and supporting environment with policies and practices that support healthy behaviors as well as parents.

Hematological Parameters in Adult Type 2 Diabetes Mellitus Patients Visiting a Tertiary Care Center of Western Nepal

Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Various mechanisms suggest changes in hematological proﬁles of Type 2 Diabetes Mellitus (T2DM) patients. Similarly, alterations in hematological proﬁles have been linked with pathogenic mechanisms in Diabetes. We aim to determine hematological proﬁles of adult

MATERIAL AND METHODS This hospital-based cross-sectional study was conducted from March 2020 to December 2020 at the department of Pathology and Biochemistry of Universal College of Medical Sciences. After ethical clearance (UCMS/IRC/016/20), 90 adult patients diagnosed with T2DM were considered. Both verbal and written consent was taken. Type 1 diabetics, patients with history of hemoglobinopathies, recent blood transfusion, chronic illnesses and acute infections, and whose peripheral smear showed dimorphic pictures were excluded.

The glycemic and hematological parameters were estimated. The data were analyzed using SPSS (version 20). Categorical data were expressed in frequency and percentage. Numerical data were expressed as median (interquartile range). Mann-Whitney U test was used to compare the hematological parameters between patients with good and poor glycemic control.

RESULTS Among the total 90 participants, 34.4% had anemia. Mean Corpuscular Hemoglobin Concentration (MCHC) correlated positively with both Random Blood Sugar (RBS) and HbA1C. RBC count and Packed Cell Volume (PCV) were signiﬁcantly higher in patients with good glycemic control, whereas MCHC was signiﬁcantly lower in that group.

CONCLUSION High prevalence of anemia was noted in T2DM patients. RBC and PCV levels were signiﬁcantly lower in patients with poor glycemic control and MCHC levels were signiﬁcantly lower in patients with good glycemic control.

Women’s Satisfaction with Hospital Based Intrapartum Care in a Medical College of Western Nepal

Srishti Bajracharya, Saraj Gurung, Sandeep Shakya — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Birth satisfaction is a multi-dimensional concept comprising structure, process and outcome of care that inﬂuence postnatal adjustment. Mother’s satisfaction during the birthing process is an important indicator in evaluating quality of maternity services. The aim of the study is to ﬁnd out the women’s satisfaction with hospital based intrapartum care in a medical college of western Nepal.

MATERIAL AND METHODS Cross-sectional analytical study was conducted to ﬁnd women’s satisfaction with hospital based intrapartum care in a medical college of western Nepal among 332 postpartum inpatient women delivered in Lumbini Medical College and Teaching Hospital, Pravas, Palpa, who were selected by using purposive sampling technique. A pretested interview schedule was used for data collection. Descriptive statistics and inferential statistics were used for data analysis.

RESULTS The study ﬁndings revealed that about half of the respondents (50.9%) were satisﬁed with hospital based intrapartum care. The level of satisfaction was signiﬁcantly associated with gravida (p=0.008), type of labor onset (p=0.007) and episiotomy status (p<0.001).

CONCLUSION The study ﬁndings conclude that women attending teaching hospital for delivery tend to be somewhat satisﬁed with hospital based intra-partum care. Adequate counseling, reassurance and supportive care of women during intrapartum period might increase their satisfaction with intrapartum care.

Ligamentum Teres Hepatis Tunnel (Pons hepatis) in Human Liver: A Case Report from Nepal

Sunil Shrestha, Nitasha Sharma, Ajay Shah — Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION The liver, the biggest gland with diverse metabolic activity consist right and left lobe, where left lobe was isolated from quadrate lobe by umbilical or ﬁssure for ligamentum teres exhibits variation. The case reported explains about the liver tissue bridge, a 2 cm long creating incomplete tunnel that connect the quadrate lobe to the left lobe corresponding to type 4 b variation of Pons hepatis. As a result, the tunnel may depict a deceptive impression of a diseased cavity due to liver parenchyma and confuse surgeons and pathologist.

Pleomorphic Adenoma of Palate: A Case Report

Sun, 31 Dec 2023 00:00:00 +0000

INTRODUCTION Pleomorphic adenoma is one of the most common benign salivary gland tumor affecting the major salivary glands mainly parotid gland of approx. 80% but infrequently the minor salivary glands of palate of approx. 7%. Salivary gland tumors are rare accounting only 2–3% of tumors occurring in head and neck region. The majority of minor salivary gland tumors are malignant in nature. The most common sites for minor salivary gland where pleomorphic adenoma arises are the palates followed by lips and cheek. This case report presents a case of pleomorphic adenoma of minor salivary gland of palate treated successfully by wide surgical excision with 1 cm healthy margin with uninvolved anatomical barrier under general anesthesia.

Why are More Women Choosing a Career in Dentistry in Nepal?

Sun, 31 Dec 2023 00:00:00 +0000

Dentistry is a very compassionate ﬁeld, making it perfect for anybody who wishes to assist others. Dentistry has always been a male-dominated ﬁeld, but in the last two to three decades more and more women have started going to dental college, and the percentage of women in dentistry has been gradually increasing. There are now more women dentists than ever, and at present women graduates in dentistry outnumber men. Female dentists may ﬁnd it difﬁcult to strike a healthy work-life balance, but many of them do it with success. Given their intelligence, creativity, and resourcefulness, women are all powerful forces to be reckoned with. They serve as role models and aid others in successfully pursuing careers in dentistry. The behavioral mecha- nisms behind the choice of career differ between men and women, and the inclination to care for others is thought by some to be more present in women than it is in men. This article discusses the reasons that lead more and more women to choose dentistry as a profession in Nepal.