Journal of Chitwan Medical College (JCMC) is an open access, peer reviewed, quarterly, multidisciplinary biomedical journal devoted to Health Sciences. JCMC is official journal of the Chitwan Medical College (CMC), Bharatpur, Nepal, published since 2010. It is meant to provide academic platform for all the medicos and also to ensure their scientific involvement in different areas medicine by promoting sharing their newer development. The JCMC [ISSN 2091-2412(Print), 2091-2889(Online)], welcomes scientific research articles, unique cases and reviews of general interest to medical researchers or medical educationists from the field of biomedical sciences. It publishes articles on the following category: Original Article, Review Article, Case Report/ Series, images in clinical sciences, Editorials, Viewpoint, Book Reviews, Medical Education, Book Reviews, Specially Invited Articles and Letter to the Editor.
ASSESSING UNDERGRADUATE STUDENTS’ KNOWLEDGE REGARDING APPLICATION OF BIOSTATISTICS IN RESEARCH AT MEDICAL COLLEGE
Background: Biostatistics is necessary in every stage of research, beginning from planning to till publication. It helps to gain importance scientifically as well as reliable results, while inappropriate use of statistical method and analysis cause harm to science and humanity. This study was aimed to assess the knowledge regarding biostatistics among different undergraduate students at medical college. Methods: A descriptive cross-sectional study was conducted in Chitwan Medical College among 117 final year students from different stream. Data was collected from 11th May, 2022 to 20st May, 2022. Standardized valid and reliable questionnaire was administered to assess the knowledge regarding application of biostatistics in research. Data was analysed by using software Statistical Package for social Sciences version 25.0. Descriptive statistics was used to calculate frequency, percentage, measure of average, measure of variation and cross tab. Chi-square test and fishers’ exact test was used to test the association between level of knowledge and selected variables. Results: This study included 117 undergraduate students of different health stream aged between 20 to 34 years with average students of Md (Q3-Q1)=23 (25-22) years being the most common age. Majority of the students were female 102 (87.2%). Only few 19 (16.2%) had good knowledge and remaining had fair knowledge regarding application of biostatistics in research. There was strongly evidence of statistically significant difference between level of knowledge and age of the students (p=0.001). Conclusions: This study concluded that only few numbers of undergraduate students had good knowledge and majority had fair knowledge regarding application of biostatistics in research.
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ROLE OF PET-CT IN EVALUATION OF DIFFERENT TYPES OF CANCER: A RETROSPECTIVE STUDY OF CANCER PATIENTS AT A DIAGNOSTIC CENTER IN NEPAL
Background: Fluorodeoxyglucose (FDG) PET (Positron Emission Tomography) is used for the evaluation of different solid cancers as well as characterization of solitary pulmonary nodules. This study was conducted with objectives to determine the prevalence of various types of cancer; to assess the status of cancer in terms of progression, regression, or static; and for metastatic workup by PET-CT scan. Methods: A retrospective cross-sectional study involving 545 patients of different cancers from all over Nepal was performed at Kundalini Diagnostic Center from July 2019 to March 2020. The data were analyzed using IBM SPSS version 22. Results: The mean age of study participants was 53.91±16.63 years. Out of total 545 participants, (499, 91.56%) tested positive for cancer with PET-CT scan with a higher proportion belonging to 50-59 years age group. Half of the participants (275, 50.46%) had disease progression and one-fifth of the participants (144, 26.42%) had static disease. Majority of the patients (139, 27.85%) were diagnosed with some form of gastrointestinal tumor. Though the data was statistically insignificant, participants with age 40-60 years were 1.18 times more likely to have cancer detected (OR 1.188, 95%CI 0.46-3.02). Conclusions: PET-CT scan is a valuable tool for assessment of characteristics of different types of cancer although differentiation of primary or a second primary or metastasis may not be possible. There is no significant association between various age groups or gender with overall cancer predisposition.
PHOTOTHERAPY INDUCED HYPOCALCEMIA IN ICTERIC NEWBORNS ATTENDING BIRAT MEDICAL COLLEGE TEACHING HOSPITAL, MORANG, NEPAL
Background: Neonatal jaundice is the single most common abnormal physical finding and the cause of morbidity in the first week of life. It is commonly managed by phototherapy. A lesser known, but a potential complication of phototherapy is hypocalcemia. This study was done to determine the prevalence of phototherapy induced hypocalcemia in icteric newborn and to compare it between preterm and term babies. Methods: This was a hospital based cross sectional study carried out in the Department of Pediatrics, Birat Medical College Teaching Hospital from 1st September 2020 to 1st March 2021. This study was performed on 201 icteric newborn that were managed with phototherapy. Serum calcium level was estimated both before initiating phototherapy and after 24 hours of phototherapy. All the data were recorded in the structured proforma. Data was analysed using SPSS version 16. Results: This study was performed on 201 icteric newborn (121 term, 80 preterm). Male babies (n=133; 66.2%) outnumbered the female babies (n=68; 33.8%). The majority of neonates were in the age group of 1-5 days (n=156; 77.6%), with mean age of4.50± 3.39 days.7.9% (16 out of 201) neonates exhibited phototherapy induced hypocalcemia. The prevalence of hypocalcemia in preterm was 10%and term neonates was 6.6%. Conclusions: Hypocalcemia is a significant problem in icteric newborn treated with phototherapy. Hence there is a need for closed monitoring of serum calcium levels. Also the risk is greater in preterm neonates as compared to the term neonates.
AWARENESS OF MENSTRUAL HYGIENE AMONG ADOLESCENT GIRLS AT A GOVERNMENT SCHOOL, CHITWAN, NEPAL
Background: Adolescence is a transition period from childhood to adult life during which pubertal development and sexual maturation take place. Menstrual hygiene and management is an issue that is insufficiently acknowledged and has not received adequate attention. Good menstrual hygiene is crucial for health, education and dignity of adolescent girls. The objective of this study was to assess the awareness and practice regarding menstrual hygiene among adolescent girls. Methods: A cross-sectional study was conducted to assess the awareness regarding menstrual hygiene among 150 adolescent girls aged 12-17 years studying in grades 9 and 10 of a government school, Chitwan. Purposive sampling technique was used to select the sample. Data were collected using structured self-administered questionnaires and analyzed by using descriptive and inferential statistics. Results: Majority of the respondents were 12-14 years old with the mean age of menarche at 12.5± 1.14 years, 52% of respondents had adequate knowledge and 61.3% of them had good practice on menstrual hygiene. Statistically significant association was found between level of practice and mother’s education status (p<0.05). Correlation between knowledge and practice score was poorly positive (r-0.087) but statistically insignificant (p>0.05). Conclusions: Majority of respondents had adequate knowledge and adequate practice on menstrual hygiene. For the maintenance of good reproductive health girl child should be made more aware about menstrual health and hygiene through the campaign and education programs.
COMPASSION FATIGUE, BURNOUT AND COMPASSION SATISFACTION AMONG NURSES WORKING IN A TERTIARY CARE HOSPITAL OF NEPAL DURING COVID-19 PANDEMIC
Background: Nurses frequently experience compassion fatigue and burnout, which have an impact on both their personal lives and patient care. The aim of this study was to assess compassion fatigue, burnout and compassion satisfaction among nurses working in a tertiary care hospital of Nepal during COVID-19 Pandemic. Methods: A cross-sectional study was conducted among 230 nurses working in Chitwan Medical College Teaching Hospital. Simple random sampling technique was used to select the study sample. Data were collected using self-administered questionnaire with Professional Quality of Life Questionnaire (ProQOL) from 15th July 2021AD to 15th September 2021AD. Data were analyzed in SPSS version 15 for window using descriptive and inferential statistics. Results: Majority of the nurses reported moderate level of compassion fatigue 177 (77.0%), burnout 176 (76.5%) and compassion satisfaction 164 (71.3%) whereas only 65 (28.3%), 8 (3.5%) and 2 (0.9%) nurses had high level of compassion satisfaction, fatigue and burnout respectively. Level of compassion fatigue and burnout were significantly associated with professional protection training. There was significant relationship found among components of ProQOL where compassion satisfaction was negatively correlated with fatigue (r= -.149: p-0.024) and burnout (r=-.487: p-0.000) but compassion fatigue and burnout were positively correlated with each other (r=0.522, p=<0.001). Conclusions: Majority of nurses working in tertiary care hospital have moderate level of compassion satisfaction, fatigue and burnout during COVID-19 crisis. Hence, effective measures need to be implemented by hospital administration to enhance the nurses’ satisfaction and to reduce fatigue and burnout during pandemic period.
KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS COVID-19 AMONG PATIENTS ATTENDING EAR, NOSE AND THROAT OUT-PATIENT DEPARTMENT AT A TERTIARY HOSPITAL
Background: The COVID-19 pandemic has ravaged the world and Nepal reported its first case on 23rd January 2020. Increasing people’s knowledge of the disease can modify attitude and change practice and is key in prevention. This study assessed the knowledge, attitude and practice (KAP) of patients presenting to the Ear, Nose and Throat (ENT) out-patient department (OPD). Methods: A hospital based cross-sectional study was conducted at the ENT OPD with 906 patients. Patients aged 20 years and above were studied regarding their KAP towards COVID-19. A questionnaire was used to collect data and analysed for gender, age group, education level and occupations. Statistical analysis was done using Mann-Whitney and Kruskal-Wallis tests. Results: Males had better knowledge and more positive attitude compared to females, which was statistically significant (p 0.001 and p 0.011). Similarly, there were significant statistical differences among the various age groups in knowledge (p <0.001), however, attitude and practice were not different. When KAP was compared to education, differences in knowledge and attitude were statistically significant p<0.001. Likewise, statistical differences existed with regard to knowledge and the various occupations (p <0.001), but a positive attitude was noted in all occupations. Practice was correct in the majority of studied groups with no statistical differences seen. Conclusions: Among the ENT patients correct practice was seen in all the groups namely, gender, age, education and occupation. However, there were differences in knowledge and attitude levels.
ANXIETY AMONG SECONDARY SCHOOL ADOLESCENTS OF BHARATPUR METROPOLITAN CITY, CHITWAN
Background: Anxiety is increasing global problem, but usually hidden from the public view. The objective of this study was to assess prevalence of anxiety among secondary school adolescents in Bharatpur Metropolitan City. Methods: A cross-sectional study was conducted in the Bharatpur Metropolitan City. Systematic sampling technique was used to select 388 higher secondary school adolescents of grade 11 and 12. Data were collected from 18 January 2021 to 14 February 2021 using self administered questionnaire. Validated Nepali version of Beck’s Anxiety Inventory was used for measuring the level of Anxiety. Data entry and analysis were done by IBM SPSS version 20 using descriptive and inferential statistics. Chi square test was used to find the association of Anxiety with independent variables. Results: Among total participants, 30.7% had anxiety symptoms in which 19.9 % had mild anxiety, 7.6% had moderate anxiety and 3.2% had severe anxiety. Marital status of parents (p= <0.001), ongoing health problems (<0.001), history of mental illness (p=<0.001), marital status (p=0.04) and gender p=0.015) of respondent were found to have association with anxiety. Conclusions: Study concluded that nearly one third of participant had reported to experienced anxiety disorder. Thus local government and school authority needs to pay special attention in addressing anxiety among adolescents by formulating different program and policies for school going adolescents in local level.
TRANEXAMIC ACID IN REDUCING BLOOD LOSS IN PROXIMAL FEMUR FRACTURE SURGERY: AN OBSERVATIONAL STUDY
Background: Blood transfusion during orthopedic surgery is associated with different types of complications. The goal of this research was to observe if tranexamic acid could help in reducing perioperative blood loss after proximal femur fracture surgery. Methods: At Shree Birendra Hospital, a total of 60 patients with proximal femur fractures participated in this one-year observational study. The study group (n=30) received 1g intravenous tranexamic acid at induction of anesthesia, whereas the control group (n=30) received intravenous normal saline. Using a proximal femoral nailing device, all patients underwent closed reduction and internal fixation. Preoperative and postoperative hematological parameters, as well as intraoperative blood loss were measured. Patients were followed up till the third day for the need of blood transfusion. Statistics Program for Social Sciences version 20.0 was used to analyze the data. Results: The study’s preoperative hemoglobin and hematocrit were 10.5±1.43gm/dl versus 10.9±1.2gm/dl and 31.5±4.19% versus 32.7±3.6%, respectively, compared to the control group. In the study versus control group, the values were 10.1±1.0gm versus 9.9±0.8gm (p=0.01) and 30.3±3% versus 29.7±2.4% (p=0.03) on day one and 10±0.69gm versus 9.68±0.51gm (p=0.049) and 30±2.07% versus 29.04±1.53% (p=0.049) on day three. Total blood loss in the study group was 156.79±43.46ml compared to 392.63±92.32ml in the control group (p=0.00), with both apparent and hidden blood loss being lower in the study group. Conclusions: In patients undergoing minimally invasive surgery of proximal femoral fractures using proximal femoral nailing system, intravenous administration of a single dose of 1g tranexamic acid at the time of induction of anesthesia lowers blood loss by a significant amount.
PREVALENCE AND FACTORS ASSOCIATED WITH EXCESSIVE SCREEN TIME AMONG YOUNG CHILDREN OF 5 TO 9 YEARS IN POKHARA METROPOLITAN OF KASKI DISTRICT
Background: Excessive screen time has been increasing among children and adolescents globally. The study aimed to find out the prevalence and associated factors of excessive screen time among young children. Methods: A cross-sectional study was conducted among children aged 5 to 9 years attending schools in Pokhara metropolitan. Face to face interview was conducted with one of the parents of 352 children. The study was carried out from March to October, 2020. Excessive screen time (ST) was defined as >2 hours screen viewing a day. Chi-square test and binary logistic regression were applied at 5% level of significance. Results: Of total, 47.4% of children had ST>2 hours a day. Among socio-demographic factors, being a boy (adjusted odds ratio (AOR), 1.65; 95% CI,1.05-2.57)), living in nuclear family (AOR, 0.62; 95% CI, 0.39-0.99) and age of the children (AOR, 1.28; 95% CI,1.03-1.58) were significantly associated with excessive ST. Having television at home, parental ST, offering screen devices to children had increased likelihood of reporting excessive ST. Odds of reporting of excessive ST was 8.97 times higher among those who had one television at home as compared to those who do not have. Excessive ST was more than three times among those children whose parents offered screen devices to make them eat as well as to have free time for the parents themselves. Conclusions: Few socio-demographic characteristics, parental ST and parental offering of screen devices were significantly associated with excessive ST. Interventions should target screen device accessibility and ST related behavior of parents.
MATERNAL AND FETAL OUTCOME IN PREGNANCY BEYOND THE EXPECTED DATE OF DELIVERY IN A TERTIARY CARE HOSPITAL OF NEPAL
Background: The risk to the mother and the fetus increase with advancing gestation age. Our study aims to study the maternal and fetal outcome in pregnancy extending beyond the expected date of delivery so that safe timings of induction and appropriate mode of delivery can be determined. Methods: We conducted a retrospective study of 152 patients with pregnancy beyond the expected date who presented to the department of Obstetrics and Gynecology, College of Medical Sciences Teaching Hospital from the time period of October 2019- November 2021.The primary outcome measures were obtained in terms of rate of cesarean section, postpartum hemorrhage, wound infection, admission in neonatal intensive care unit, birth asphyxia and meconium aspiration syndrome. Statistical analysis was performed using Chi-square test with P value <0.05. Results: The majority of 86 (56.58%) patients were between 40-41 weeks of gestation. Maximum number of vaginal deliveries were seen between 40-41weeks (77.90%). Overall cesarean section rate was 40.13% with maximum number between 41-42 weeks (64.28%). Fetal distress with meconium-stained liquor was the most common indication (36.06%). The rate of neonatal intensive care unit admission was 16.44% with birth asphyxia (12.50%) and meconium aspiration syndrome (8.55%) as the primary cause for admission. Maternal complications like oligohydramnios, postpartum hemorrhage, wound infection, cervical tear, shoulder dystocia was seen in 16.45%, 1.97%, 1.97%, 2.63% and 1.31% respectively. Conclusions: The pregnancy beyond the expected date causes definite risk to the mother and the fetus. Therefore, strict fetal surveillance with early induction of labor prior to expected date of delivery is recommended for better fetomaternal outcomes.
ASSESSMENT OF ACCURACY AND PRECISION STATISTICS IN ROUTINE BIOCHEMISTRY AUTOANALYZER USING INTERNAL QUALITY CONTROL SPECIMENS IN A TERTIARY CARE HOSPITAL LABORATORY
Background: Accuracy and precision are two important yardsticks of a reliable analytical system in the clinical laboratory. The study was designed to determine the accuracy and precision statistics of a routine biochemistry auto-analyzer using two levels of quality control materials and to compare these statistics with the company provided values. The study also aimed to compare the month-wise variations in these statistics. Methods: It was a cross-sectional study conducted in the Department of Biochemistry at Birat Medical College Teaching Hospital, Nepal. Laboratory data for the months of May–July, 2021 were retrieved from the laboratory information system (LIS). The retrieved data comprised of the results of two levels of quality control specimens run routinely on Beckman Coulter AU480 biochemistry autoanalyzer for most of the biochemical parameters. Accuracy and precision statistics were calculated as mean and coefficient of variation, respectively. Results: In both levels of control samples, the laboratory determined accuracy statistics were greater in magnitude than the company provided ones for albumin, alkaline phosphatase, aspartate transaminase, creatinine, unsaturated iron binding capacity, urea, direct bilirubin, and amylase; the precision statistics were similarly greater in magnitude for total protein and magnesium. In month-wise comparison of laboratory determined accuracy statistics, the overall mean differences were statistically significant (p<0.05) for all parameters except lactate dehydrogenase and magnesium (both levels of control). Conclusions: The laboratory determined accuracy and precision statistics showed variations from the company provided ones apart from the month-wise variation. Therefore, continuous monitoring of these values is mandatory for ensuring reliable test reports.
ADHERENCE TO IRON AND FOLIC ACID SUPPLEMENTATION AND PREVALENCE OF ANAEMIA AMONG PREGNANT WOMEN AT A TERTIARY CARE HOSPITAL
Background: Anaemia is characterized by a reduced oxygen-carrying capacity of blood and causes various health problems in people of all ages, including pregnant women. The most common cause of anemia is a lack of iron in the diet. Prevention of anaemia requires strict adherence to iron and folic acid supplementation during pregnancy. The main objective of this study was to gather information on adherence to iron and folic acid supplementation and anaemia prevalence among pregnant women. Methods: The cross-sectional study was conducted among 200 postpartum mothers in the obstetrics ward of Universal College of Medical Sciences. Eligible participants were interviewed using a questionnaire to measure their adherence to iron and folic acid supplementation during pregnancy. Haemoglobin levels were recorded to check the presence of anaemia. Multivariable regression analysis was used to find the relationship between independent and dependent variables. Results: Total 164 (82%) participants had good adherence to iron and folic acid supplementation. Participants who started their antenatal care visit in first trimester were more adherent to iron and folic acid supplementation (AOR = 0.13, 95% CI (0.05–0.39)). The prevalence of anaemia was 24%. Anaemic participants were less likely to adhere to their iron and folic acid supplements (AOR = 0.26, 95% CI (0.11–0.63)). Conclusions: The adherence of participants to iron and folic acid supplementation was good and significantly associated with gestational age when antenatal care visit was started, child birth weight and anaemia. By strengthening the national level awareness campaign, we can further improve the adherence rate and prevent anaemia.
ASSOCIATION OF METABOLIC SYNDROME AND SUBCLINICAL HYPOTHYROIDISM PATIENTS ATTENDING CHITWAN MEDICAL COLLEGE
Background: Metabolic syndrome is characterized by a cluster of cardiovascular risk factors such as abdominal obesity, dyslipidemia, hyperglycemia, and hypertension. Subclinical hypothyroidism is defined as an increase in serum levels of thyroid stimulating hormone (TSH) above the normal range, without alteration of total T4 concentrations has been associated with various metabolic alterations. The study aimed to investigate association between metabolic syndrome and subclinical hypothyroidism patients attending Chitwan Medical College. Methods: This cross-sectional study consisted of 250 randomly selected individuals visiting OPD in the Department of Medicine of Chitwan Medical College 10ml of blood sample was drawn from antecubital vein following overnight fasting. Fasting blood sugar, lipid profile and thyroid profile etc. were analyzed via chemiluminescence Analyzer at Hospital Laboratory and was statistically analyzed. Results: The association of BMI with T4 and TSH was found to be positively correlated and was significant at P<0.05 but the association of systolic blood pressure (SBP) with T3 was not significant but there was negatively significant correlation of SBP with T4 and TSH. The correlation of diastolic blood pressure (DBP), TG, HDL, fasting blood sugar were not significant with T3, T4 and TSH at p<0.05. BMI was positively correlated with T4 and TSH (r = 0.12, P<0.05 and r=0.81, P<0.001) whereas SBP was negatively correlated with T4 and TSH (r = -0.12, P<0.05 and r=-0.16, P<0.001 respectively). Conclusions: From our study it was concluded that the association of BMI with T4 and TSH was found to be positively correlated in subclinical hypothyroidism subjects.
EVALUATION OF SERUM URIC ACID, GLUCOSE AND OTHER GLYCEMIC PARAMETER IN TYPE II DIABETIC INDIVIDUALS
Background: In spite of antioxidant property serum uric acid (SUA) has a positive association with blood glucose. SUA is considered as a strong and an independent risk factor for diabetes but low serum level of uric acid has been reported in the hyperglycemic state. Diabetes mellitus is a metabolic disorder of multiple etiologies resulting from defect in insulin action. So, aim of this study is to assess whether there is any change in SUA level and to establish whether there is any association with type II diabetes mellitus (DM) or not. Methods: A cross sectional study was conducted in 264 cases of DM. SUA, fasting blood glucose (FBG), post-prandial blood glucose (PPBG) and glycated hemoglobin (HbA1c) level were measured. Pearson’s correlation was employed to calculate the ‘r’ value by using SPSS version 15. Results: In our study prevalence of hyperuricemia was 18.5%. Mean SUA in male and female was 5.95 mg/dl and 5.54 mg/dl respectively in DM. HbA1c has positive correlation with FBG and PPBG (r value = 0.720 and 0.775, respectively p=<0.001), while SUA has negative correlation with HbA1c, FBG and PPBG (r value= -0.179, p =0.004, -0.070, p=0.257 and -0.078, p=-0.204 respectively.). Conclusions: SUA level is increased in DM. SUA was high among male and SUA initially increased when FBS and HbA1c increases then decreases as FBG and HbA1c level were further increased. SUA has negative correlation with FBG, PPBG and HbA1c, while HbA1c has a positive correlation with FBG and PPBG
QUALITY OF LIFE AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE ATTENDING IN MEDICAL OPD OF CHITWAN MEDICAL COLLEGE, CHITWAN
Background: Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide which can severely impair the individual’s quality of life. The study aimed to assess the quality of life of patients having chronic obstructive pulmonary disease. Methods: A cross-sectional hospital-based study was conducted in medical OPD of Chitwan Medical College. Purposive sampling technique was used to select 203 patients with chronic pulmonary obstructive disease for at least 3 months. Data were collected from July 16, 2021 to January 14, 2022 using a WHO Quality of Life Scale-Brief through face-to-face interview. Transformation of the scores was done to standardize the raw scores by using the formula applied for linear transformation is as follows: [(Actual raw score - Lowest possible raw score)/Possible raw score range]*100. Results: The mean score and standard deviation of total QOL was 40.64 ± 18.41, where 52.23 ± 13.68 for physical, 47.84 ± 9.70 for psychological, 66.63 ± 9.25 for social and 54.62 ± 13.44 for environment domain showing higher impairment in psychological. Sex (0.031), type of family (0.042), educational status (<0.001), smoking habit (0.005) and duration of COPD (<0.001) were found statistically significant with total QOL of COPD patient. Conclusions: This study showed an impaired quality of life in COPD patients. Longer disease duration and smoking habit of patient impacted negatively on their QOL. Hence, attention should be paid by health professional for enhancing QOL by addressing those factors while treating them in health care setting
PRETREATMENT WITH ONDANSETRON IN PREVENTION OF PAIN ON PROPOFOL INJECTION
Background: Pain on intravenous injection of propofol is seen in almost 70% of patients without any pretreatments. This study was conducted to evaluate the effect of ondanse­tron in reducing the occurrence of pain on intravenous injection of propofol. Methods: Two hundred and thirty-two patients aged between 18- 60 years of either sex belong­ing to ASA status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia at Chitwan Medical College, Bharatpur, Nepal, from from September 1, 2020 to March 31, 2021 were recruited in this study. They were assigned randomly into two groups with 116 participants in each, where Group 1 received 2 ml (4 mg) of ondansetron and Group 2 received 2 ml of 0.9% saline (placebo) intravenously as the pretreatment solution prior to injection of propofol for induction of general anesthesia. The overall incidence of pain in the saline group was 84.5% compared to 48.3% in the ondansetron group (P < 0.001). Result: Pain was of mild intensity in most patients who belonged to the ondansetron group (33.6%) whereas it was of moderate intensity in most participants of the saline group (54.3%). Few patients in the study group experienced severe pain (0.9%) as compared to the placebo group (9.5%) with P < 0.001. Conclusion: Therefore, it was concluded that pretreatment with ondansetron may be a useful intervention in reducing the incidence of pain on intravenous propofol administration without any adverse effects in significant number of patients.
PERCEPTION OF MBBS AND BDS INTERNS OF CHITWAN REGARDING THEIR CLINICAL POSTING DURING COVID-19 PANDEMIC
Background: COVID-19 pandemic has changed the routines throughout the world where medical sector hasn’t remained untouched. Medical interns have been the vulnerable population being affected by the pandemic. The pandemic has created a huge impact psychologically and academically on the medical students. This study was conducted in the medical colleges of Chitwan, Nepal aiming to find out the perception of the MBBS and BDS interns regarding their clinical posting during COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted among MBBS and BDS interns of medical colleges in Chitwan, Nepal. A structured 14 item questionnaire containing demographics (4 items) and perceptions on safety, satisfaction and confidence (10 items) regarding COVID-19 pandemic was used for online survey via email. Consent was taken for the survey and descriptive study was done. Data entry was done in Microsoft Excel and analysis is SPSS 16. Descriptive statistics was done. Results: The questionnaire was sent to 130 interns at Chitwan out of which 68 interns responded among which 29.4 % were BDS interns and 70.6 % were MBBS interns. Majority of the interns didn’t feel safe to do duty in their internship and also feared of transmission of COVID-19 through them to their families. They also didn’t have adequate confidence for the patient management due to the type of learning exposure during the pandemic. Conclusions: The study revealed that virtual learning isn’t effective for the interns for the patient management. Majority of the interns at Chitwan didn’t feel safe to do clinical duty during the pandemic.
PROSTATE BIOPSIES AND ITS ASSOCIATION WITH PROSTATE SPECIFIC ANTIGEN IN PATIENT ATTENDING BIRAT MEDICAL COLLEGE TEACHING HOSPITAL
Background: Prostate cancer is the most common malignant tumor in men over the age of 65 years. Most frequently encountered diseases of the prostate are benign prostatic hyperplasia, prostatitis and carcinoma. Prostate specific antigen is a tumour marker and is expressed by both normal and neoplastic prostate tissue. This study was done to determine the association between histopathological diagnosis in prostatic biopsy and serum prostatic specific antigen level. Methods: This was a hospital based cross sectional study carried out in the Department of Pathology, Birat Medical College from February 15, 2020 to October15, 2020. All consecutive patients attending the pathology department with prostate biopsy and serum PSA level were included in the study. Histopathological examination was done and its association with serum prostatic specific antigen level was done. Results: In the biopsy findings, Benign Prostatic Hyperplasia (BPH)was the most common case seen in 41 (48.8%) cases out of 84 cases. Majority of benign cases (BPH and BPH with prostatitis) were seen in the PSA range of 0-7ng/ml. Maximum cases of adenocarcinoma were seen in the range of >20ng/ml. Chi-Square test showed a value of 5.89 while P value was <0.01 indicating that the increasing serum PSA level is associated with higher chance of adenocarcinoma. Conclusions: PSA is a specific marker for prostatic tissue. It can be raised in benign lesions of the prostate due to membrane disruption. However, an increased PSA level above 20 ng/ml increases the chance of detecting malignant lesions.
SELF-CARE MANAGEMENT AND ITS ASSOCIATED FACTORS AMONG PATIENT WITH HYPERTENSION IN NEPAL
Background: Hypertension is currently a common and serious health issue that leads to cardiovascular disease and premature death around the world. Self-care practice is essential for blood pressure control and reduction of hypertension complications of cardiovascular and renal diseases. The objective of this study is to assess the level of self-care management and its associated factors among patients with hypertension. Methods: The cross-sectional study was conducted at the Internal medicine and Cardiac outpatient department of Kathmandu University Hospital, Dhulikhel on 386 participants diagnosed with hypertension with six months of diagnosis and age of 30-80 years. The participants were recruited conveniently in the study. Face to face interviews with participants using Hypertension Self-Care Profile (HTN-SCP) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess self-care management and perceived social support. Descriptive and inferential statistics were performed using SPSS version 23. Results: The mean age of the participants was 57.39 years. Half of the participants (52.3 %) had poor self-care practice. There is significant association between level of self-care practice with religion (p= <0.001), educational level (p= <0.001), area of residence (p= 0.001), income (p=<0.001) and perceived social support (p= 0.001). Conclusions: The present study revealed that half of the participants had poor self-care practice. Based on the results, the study concluded that good self-care practices and social support influence better self-care practice among hypertensive patients which may eventually help to prevent complications in the coming future.
FACULTY PERCEPTION TOWARD ONLINE EDUCATION DURING THE COVID-19 PANDEMIC
Background: COVID-19 outbreak has changed the education system from traditional class­room to online education across the world. Due to need for social distancing, countries were bound to close the educational institutions and adapt online learning as the only means available for learning. Although, this has provided teachers an opportunity to work from home, at the same time it has brought many challenges. Therefore, understanding faculty perception is an important aspect for successful implementation of online education. Thus, this study aimed to identify the faculty perception toward online education during COVID-19 pandemic. Methods: Cross-sectional online survey was conducted from December 2020 to September 2021 during both the 1st and 2nd wave of COVID-19 Pandemic and lockdown in Nepal. Convenience sampling was used to select the faculty members from different universities across different places of Nepal. Self-developed five-point Likert scale was used to assess faculty perception toward on­line education. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16 using statistical tool like frequency, percentage, mean and standard deviation. Results: Total 394 faculty members participated in the study. More than half 271 (68.8%) of the respondents had positive perception, whereas, only 123 (31.2%) had negative perception toward online education. The mean score of perception of was 3.14±0.279. Conclusions: More than half of the faculty had positive perception toward online education, which concludes that, online education can be an effective means of continuing education during the crisis situations like COVID-19 pandemic. However, the finding of this study offers useful sugges­tion for policy makers and stake holders to develop proper strategies and on-going professional development courses and training programs to successfully implement online education program.
KNOWLEDGE AND PRACTICES OF WATER SANITATION AND HYGIENE IN SLUM DWELLERS OF BHARATPUR METROPOLIS WARD NO 5
Background: Access to Water, Sanitation and Hygiene (WASH) is a pre-condition for people to acquire good health, well-being and benefit from economic development. Slum dwellers are likely to be among the most deprived people for WASH in developing countries like Nepal. Methods: A cross sectional study was conducted to find the level of knowledge and existing practices among slum dwellers of Bharatpur Metropolis Ward no 5. A total of 173 female household head were identified through census method and interviewed with semi structured interview schedule and analyzed with descriptive statistics by using SPSS 20. Results: Nearly around two third of the respondents (65.3%) had good knowledge of WASH. Regarding the practices, the study showed that only 42 percent of respondents had access to piped drinking water in their premises and almost all households (94.8%) didn’t use any purification method for drinking water. In total 59 percent had latrine in their household and half of total respondents (52%) washed their hands with water and soap after defecation. Around 24.2 percent washed their hands regularly after touching garbage. In total 60 percent or respondents disposed solid waste properly in manure pit (8.7%) and government vehicle (30.6%) and15 percent disposed liquid waste in a pit. On bivariate analysis, age, marital status, and education was found to have significant association with knowledge of WASH (p<0.05). Conclusions: Mass and family centered behavioral change educational programs at slum settings are urgently needed to raise knowledge and good practices regarding WASH.
PREVALENCE OF SEXUAL HARASSMENT IN PUBLIC TRANSPORTATION AMONG FEMALE STUDENTS OF A PUBLIC COLLEGE AT BHARATPUR, NEPAL
Background: Sexual harassment in public transportation has been recognized as a worldwide serious problem, particularly among women. However, the exact figure of the sexual harassment in transit places is still unknown. Therefore, this study aims to identify the prevalence of sexual harassment in public transportation among the female students of a public college at Bharatpur. Methods: A descriptive cross-sectional study consisted of 196 female students who studied in the 12th standard of various academic streams of Saptagandaki Multiple Campus of Bharatpur. Stratified proportionate random sampling technique was used for selection of the desired sample. Structured questionnaire was used and data was collected from 2076/ 03/15 B.S to 2076/03/27 B.S through web - based survey. Data analysis was performed in SPSS version 20 for window using descriptive statistics. Results: Majority, i.e. 82.1% of the respondents experienced sexual harassment in public transportation of which 85.1% experienced verbal harassment followed by physical harassment (80.1%) and non- verbal harassment (70.8%). Male passengers were the main perpetrators involved in physical (82.8%), verbal (75.2%) and non- verbal harassment (81.6%). Furthermore, the study revealed that the highest (96.3%) of the participants did not file the complaint because of fear. Conclusions: Sexual harassment in public transportation was found to be significantly higher in female students. Therefore, government and concerned authorities need to adopt zero tolerance rules, regulation ad policies towards any form of sexual harassment in public spaces.
PROFILE OF ACUTE GASTROENTERITIS IN CHILDREN UNDER FIVE YEARS OF AGE, AND THEIR ASSOCIATION WITH BLOOD UREA NITROGEN-TO-CREATININE RATIO
Background: Acute gastroenteritis (AGE) is a major cause of childhood morbidity and mortality, especially in developing countries. This study aimed to explore the clinical and laboratory profile in under five children with AGE. It furthermore aimed to study the association of socio-demographic and clinical parameters with blood urea nitrogen and serum creatinine ratio (BCR). Methods: This was a cross-sectional study carried among 62 under-five children in the Pediatric Department, Nepalgunj Medical College and Teaching Hospital. Data was entered in excel and analyzed in statistical package for social sciences. Demographic and clinical data obtained from informants was presented as frequency and percentage. BCR was calculated based on baseline serum urea and creatinine values. Chi square test and logistic regression were used to study the association of clinical and demographic profiles with BCR. Adjusted odds ratio was calculated at 95% confidence interval. Results: The mean age of participants was 26 months. Most of the children belonged to low socio-economic status (44, 70.97%). Dehydration was the commonest clinical association (51,82.25%) followed by fever (31,50%) and abdominal pain (31,50%). Multivariate logistic regression showed that children with dehydration had greater odds (Adjusted odds ratio (AOR)=5.82) of having BCR greater than 20:1 as opposed to those without dehydration. Conclusions: AGE was commonly seen in children with low socio-economic status. Dehydration, fever and abdominal pain were common clinical associations. High BCR (20:1) was positively associated with presence of dehydration in children presenting with acute gastroenteritis.
SERUM LIPID PROFILE AMONG POST-MENOPAUSAL WOMEN ATTENDING TERTIARY HOSPITAL AT CHITWAN, NEPAL
Background: Menopause is a phase of woman’s natural aging process and is marked by the cessation of ovarian function. The increased incidence of cardiovascular risk in post-menopausal women may be due to hormonal imbalance leading to derangement of lipid profile. The aim of study was to study the serum lipid profile among post-menopausal women attending at a tertiary care hospital in Nepal. Methods: This was a hospital based descriptive cross-sectional study carried out among 156 post-menopausal women attending Medicine Out Patient Department at Chitwan medical college and teaching hospital. Serum Lipid profile were measured by an automated on Dimension® clinical chemistry analyzer and serum estrogen was measured by CLIA on Siemen ADVIA Centaur XP immunoassay. Data were analyzed using SPSS version 20. Results: Study finding suggests that serum Triglycerides, Total cholesterol, and LDL were found to be elevated in 48.7%, 23.7% and 14.7% study participants respectively while serum HDL level was found to be low in 10.9% study subjects. Serum HDL had significantly associated with different age groups and estrogen(p<0.05). The serum TG, TC, and LDL were negatively correlated (r = -0.096, p = 0.23), (r = -0.09, p = 0.22), (r = -0.18, p = 0.04) with estrogen respectively while serum HDL was positively correlated (r = 0.32, p = 0.01) with estrogen. The serum TG, TC, LDL were negatively correlated with age and serum HDL was positively correlated with age. Conclusions: Due to changes in lipid profiles and the loss of estrogen’s cardio preventive impact, post-menopausal women are at an increased risk of developing cardiovascular disease.
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING AUTOGRAFT USING BIOABSORBABLE VERSUS TITANIUM INTERFERENCE SCREW IN TIBIAL TUNNEL IN GOVERNMENT HOSPITAL OF WEST NEPAL
Background: Arthroscopic anterior cruciate ligament reconstruction can be performed both with titanium and bioabsorbable interference screws. The purpose of this study was to com­pare functional outcomes after reconstruction using these different implants. Methods: This was a retrospective study. Patients who underwent ACL reconstruction with ham­string autograft at Bheri hospital over the designed period were observed. Each group (titanium and bioabsorbable screws) consisting of 20 patients were compared using Lyshlom knee scores at 3, 6 and 12 months postoperatively. Statistical analysis was done using SPSS version 24. Chi square test was applied for comparing functional outcomes. Confidence interval of 95%, p value less than 0.05 was taken as significant. Results: Mean Lyshlom scores at 3, 6 and 12 months were 61.70, 69.60 & 85.90 for titanium group and 62.65, 70.95 & 84.65 for bioabsorbable screw group. The differences were not statistically significant. Conclusions: Functional outcomes at each follow up was equivalent among patients using either titanium or bioabsorbable screws.
CORRELATION OF HAMSTRING GRAFT SIZE WITH ANTHROPOMETRIC MEASUREMENTS IN PATIENTS UNDERGOING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AT CHITWAN MEDICAL COLLEGE
Background: Injury to Anterior Cruciate Ligament (ACL) commonly occurs in knee injury usually requiring surgical intervention. Use of hamstring autograft for ACL reconstruction (ACLR) is commonly practiced. Many factors govern the selection of graft. Literature lacks studies showing correlation between anthropometric measurements of patients and the size of hamstring tendon graft in ACLR in Nepalese population. This study aimed to correlate anthropometric measurements to diameter and length of graft obtained. Methods: Cross sectional study was carried out from 17th April 2021 to 15th March 2022 and approved by CMC-IRC (Ref: CMC-IRC/078/079-094) and evaluating patients who have undergone surgery in Anthropometric measurements along with thigh length and circumference was measured pre-operatively. Length and diameter of prepared graft was measured intraoperatively before insertion. Forty (n=40) patients of mixed age, sex and ethnicity undergoing Arthroscopic ACLR were included. Statistical analysis was done to find correlation between anthropometric measurements and graft size harvested. Purposive sampling technique was used. Data collection was done in proforma. Data entry was done in Excel and and analysis was done in SPSS version 21. Results: Statistical analyses showed strong positive correlation between patient’s thigh length and graft diameter. Height shows positive correlation with graft length and diameter. Weight shows positive correlation with graft length. There was very low correlation of other variables with graft diameter and length which were statistically insignificant. Conclusions: Positive correlation factors (thigh length, height and weight) can be utilized to anticipate good quality graft and can be used during ACLR.
ROLE OF HERBAL EXTRACTS IN ROOT CANAL DISINFECTION AND REMOVAL OF SMEAR LAYER: A REVIEW
Background: The success of endodontic treatment depends on the complete debridement and disinfection of canal space. Various chemicals have been used for canal disinfection. However, to overcome the adverse effects, toxicity issues, and microbial resistance of most conventional canal disinfectants, alternative agents are needed. Many herbal products have been studied and recommended for canal disinfection. This article aimed to review the role of herbal extracts in canal disinfection as an irrigant, intracanal medicament, and their efficacy in smear layer removal. Results: Studies were identified through search of the following electronic databases: PubMed, Science direct, Scopus and Google Scholar. The search was undertaken with keywords herbal agents/ products for root canal disinfection, Enterococcus faecalis, endodontics, smear layer, biofilm, herbal extracts and antimicrobial activity. The literature was reviewed for past 30 years (1990- till June 2020). The results showed that several in-vitro studies reported effective antimicrobial action of herbal extracts for canal disinfection, however, very less in-vivo or clinical studies have been reported to ascertain the use of these agents for endodontic therapy. Conclusions: The study concludes that herbal agents can be effectively used for canal disinfection. However, long-term, invitro, clinical, biocompatibility studies clinical trials are further needed to confidently use these products in endodontics. Herbal extracts can be used as substitute to existing root canal disinfectants due to their unique properties. Therefore, improving the endodontic success rate by preventing root canal failures, persistent and reinfections.
Copyright (c) 2022 Swapna Munaga, Kiran R Halkai, Abdul Kader Al Jarrah, Rajkiran Chitumalla, Rahul Halkai, Sheeba Khan https://creativecommons.org/licenses/by-nc/4.0
USEFULNESS OF MIXED METHOD RESEARCH DESIGN TO UNDERSTAND HEALTH SEEKING BEHAVIOR
Mixed Methods Research Design (MMRD) has been used as a more potent approach in the research field of social and behavioral science. The purpose of this article is to explore and provide information on mixed methods study design. Secondly, the article discusses different categories and perspectives of health-seeking behavior from multiple angles of real social life. Thirdly, it focuses on the relevance and applicability of mixed-method design in understanding subjective and objective aspects of health-seeking behavior acting at the person, family, and community level, such as bio-social profiles and previous experiences with health care. The article has also briefly summarized the philosophy of mixed methods research design and different perspectives on health-seeking behavior. Mixed methods research, is one of the three major research paradigms (quantitative research, qualitative research, and mixed methods research) that is most appropriate to comprehending complicated subjective and objective facts associated to health-seeking behavior. This article will contribute to understanding the strength of mixed-method research design and its use with more holistic thinking on the issues pertaining to health-seeking behavior and human behavior.
Copyright (c) 2022 Ashok Kumar Paudel, Muni Raj Chhetri, Ambika Baniya, Mamta Chhetri, Rashmi Thapa https://creativecommons.org/licenses/by-nc/4.0
MONKEYPOX – ANOTHER OPPORTUNITY TO ADOPT PUBLIC HEALTH MEASURES AFTER COVID-19
Copyright (c) 2022 Muni Raj Chhetri, Kapil Amgain https://creativecommons.org/licenses/by-nc/4.0