Journal of College of Medical Sciences-Nepal <p>Official journal of the College of Medical Sciences, Bharatpur, Nepal. Full text articles available. Also available at <a title="JCMS-Nepal" href="" target="_blank" rel="noopener"></a>.</p> <p>Journal of College of Medical Sciences-Nepal is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> International Society of Medical Education Pvt. Ltd. en-US Journal of College of Medical Sciences-Nepal 2091-0657 Methotrexate Induced Severe Bone Marrow Suppression with Low Dose <p>Methotrexate is a first line drug for Rheumatoid arthritis. It is also being used for various autoimmune diseases and in cancer as a chemotherapeutic agent for decades. It works as a folic acid antagonist in cancer. However it works by inhibiting enzyme AICAR and thereby raising intracellular adenosine in autoimmune diseases. Adverse effects can range from mild gastrointestinal disturbance to severe life-threatening pancytopenia, hepatotoxicity, infection and lymphoproliferative disorders requiring hospital admission. Before initiating this drug physician should be aware of its potential harmful effects especially in old and co-morbid patients. Complete blood count, Liver and kidney function test and serology are essential before considering this drug.</p> Sushil Adhikari Nishan Tiwari Swapnil Sharma Abinash Pokharel Copyright (c) 2022 Sushil Adhikari 2023-02-08 2023-02-08 18 4 440 442 10.3126/jcmsn.v18i4.48546 Ultrasound Evaluation of Normal Thyroid Size <p><strong>Introduction</strong><br />Normal thyroid size determination is very important for the accurate diagnosis of various thyroid disease. There are different thyroid pathologies which lead to increase in size of the thyroid gland, therefore it is essential to know the accurate dimension of the thyroid gland. This study was aimed to evaluate the normal range of thyroid gland dimensions.<br /><strong>Methods</strong><br />The study was a descriptive cross-sectional study conducted on 115 patients, in Department of Radiology and Imaging, College of medical sciences, Bharatpur, Nepal. All ultrasound examinations were performed using Toshiba Aplio 500 superficial probe. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS, Inc., an IBM Company, Chicago, IL). Descriptive statistics was used to analyze the data. <br /><strong>Results</strong><br />Among the 115 patients who participated in the study, 24 (20.9%) were male and 91 (79.1%) were female. The mean length of the right lobe was more (3.67±0.338 mm) than in the left lobe (3.45±.423 mm). The overall mean volume of thyroid gland was 6.71±2.05 ml. The mean volume of thyroid gland in males was 7.91±2.91 ml and in females was 6.40±1.63 ml.<br /><strong>Conclusions</strong> <br />The present study estimated the normal dimension of thyroid gland. The normal dimension of thyroid gland volume was found to be more in male than in female. The mean total volume was found to be similar to the earlier published study from Nepal. </p> Prabhat Basnet Ashutosh Kumar Singh Hari Prasad Upadhyay Rajib Chaulagain Copyright (c) 2023 Prabhat Basnet 2023-02-08 2023-02-08 18 4 315 320 10.3126/jcmsn.v18i4.50275 Clinicopathological Study of Upper GI Malignancy in Tertiary Care Centre of Nepal <p><strong>Introduction</strong><br />Upper gastrointestinal malignancies are among the most common causes for cancer related morbidity and mortality. These cancers rapidly progress to advanced stages even in the absence of significant symptoms, thus leading to delayed diagnosis and dismal prognosis. The aim of this study was to determine the prevalence, type and clinicopathological characteristics of upper gastrointestinal tumors.<br /><strong>Methods</strong><br />This was a three year cross-sectional study involving 66 patients of upper gastrointestinal cancer. The study was conducted from March 2018 to February 2021 at the college of medical sciences-Teaching Hospital, Nepal. Relevant clinical information, Endoscopic pattern and histological characterization were recorded. SPSS version 25.0 was applied for statistical analysis. <br /><strong>Results</strong><br />Total 66 patients were enrolled into this study. The mean age of the population was 59.13± 13.38 years with male predominance (M:F-1.36:1). Common presenting symptoms were abdominal pain (76%), significant weight loss (61%), vomiting (40%). About 77% of the tumors were located in the stomach, 17% in the esophagus and 6% in the first and second part of the duodenum. Most common endoscopic pattern of upper gastrointestinal lesion was ulceroproliferative type (53%).Tissue histology showed adenocarcinoma as the commonest histological pattern with 82% followed by squamous cell carcinoma 10%.<br /><strong>Conclusions</strong> <br />These malignancies can rapidly progress to advanced stages even in the absence of serious symptoms and endoscopy is needed in suspected patients to avoid delayed diagnosis and improve the disease outcome. <br /><br /></p> Ajay Kumar Gautam Khus Raj Dewan Bhanumati Saikia Patowary Copyright (c) 2023 Ajay Kumar Gautam, Khus Raj Dewan 2023-02-08 2023-02-08 18 4 321 329 10.3126/jcmsn.v18i4.48924 Association between Superior Attachment of Uncinate Process and Frontal Sinusitis <p><strong>Introduction</strong><br />The uncinate process (UP) is a sickle shape bone. The superior attachment of uncinate process can be into the lamina papyracea (Type I), the skull base (Type II) and the middle turbinate (Type III). Drainage of the frontal sinuses depends on the superior attachment of the UP and alterations in drainage predisposes to sinusitis. This study looked at the association between the superior attachment of UP and chronic frontal sinusitis. <br /><strong>Methods</strong><br />A cross sectional study was conducted in the Otorhinolaryngology out-patient department. Patients were diagnosed as chronic rhinosinusitis according to the American Academy of Otolaryngology–Head and Neck Surgery Rhinosinusitis Task Force criteria. Patients then underwent a non-contrast CT scan of paranasal sinuses. Superior attachment of the UP was noted from the CT, and the association between the superior attachment of the UP and chronic frontal sinusitis was recorded. <br /><strong>Results</strong><br />Among the 144 sides examined it was seen younger (20-29 years), female (52.8%) patients were more affected by the condition. The most common superior attachment of the UP was into the lamina papyracea on right and left sides were 75% and 73.6%. There was a significant association between the superior attachment of the uncinate process and chronic frontal sinusitis (p=0.001 and .002) on both sides. <br /><strong>Conclusions</strong> <br />Among the superior attachments of the uncinate process, attachment into the lamina papyracea was the commonest. It was noted that chronic frontal sinusitis was significantly associated with the superior attachment of the uncinate process.<br /><br /></p> Anupama Shah Rijal Abhushan Siddhi Tuladhar Rupesh Raj Joshi Kundan Kumar Shrestha Anup Dhungana Copyright (c) 2023 Anupama Shah Rijal, Abhushan Siddhi Tuladhar, Rupesh Raj Joshi, Kundar Kumar Shrestha, Anup Dhungana 2023-02-08 2023-02-08 18 4 330 337 10.3126/jcmsn.v18i4.49207 Risk Factors for Neonatal Sepsis: A Case-Control Study in A Tertiary Level Hospital of Nepal <p><strong>Introduction</strong></p> <p>Neonatal sepsis is estimated to be a major contributor to neonatal mortality and morbidity with a higher burden in low and middle income countries (<strong>LMICs</strong>). Studies have shown that neonatal sepsis is associated with the neonatal and maternal characteristics and obstetric care received. Hence, this study aims to determine the risk factors of neonatal sepsis among neonates admitted to a Neonatal Intensive Care Unit (NICU) of a tertiary level hospital in Nepal.</p> <p>&nbsp;</p> <p><strong>Methods</strong></p> <p>A hospital-based unmatched case-control study was conducted from 1<sup>st</sup> April 2020 to March 31<sup>st</sup> 2021 in the NICU, Department of Pediatrics at College of Medical Sciences &amp; Teaching Hospital, Chitwan Nepal. A structured questionnaire was used for data collection of neonatal and maternal characteristics. Neonatal characteristics included neonates’ age, sex, birthweight and APGAR score at first and fifth minute after birth. Maternal characteristics included maternal age, para, gravida, antenatal visits and others. Data were analyzed using STATA-13. Univariate and multivariate logistic regression were applied to test the association between independent variables and neonatal sepsis. Statistical tests were considered significant at a p-value &lt; 0.05 (95% CI).</p> <p><strong>Results</strong></p> <p>A total of 210 suspected neonatal sepsis cases were compared with 70 controls. We obtained statistical significance (p&lt;0.05) among age, Apgar score at 5 minutes of birth, ANC visits, resuscitation at birth and gestation age with the neonatal sepsis among neonates.</p> <p><strong>&nbsp;</strong></p> <p><strong>Conclusion</strong></p> <p>This study concluded that age and sex of neonates, Apgar scores at 5 minutes of birth, ANC visits, resuscitation at birth and gestation age were significantly associated with neonatal sepsis. Findings suggest the need for careful handling of neonates with routine screening for sepsis. This study will stimulate future researcher to conduct matched case control study, which will be benefitting the policy makers in crafting preventive strategies.</p> BalaKrishna Kalakheti Anupama Bishwokarma Bandana Paneru Kiran Sharma Copyright (c) 2023 Bal Krishna Kalakheti, Anupama Bishwokarma, Bandana Paneru, Kiran Sharma 2023-02-08 2023-02-08 18 4 338 347 10.3126/jcmsn.v18i4.51085 Prevalence of Exclusive Breastfeeding and Factors Influencing Infant Feeding Practices among Mothers of Central Nepal <p><strong>Introduction</strong><br />Infants should be exclusively breastfeed for the first six months of life to achieve optimal growth, development and health. Considered as an ideal food for infants, it also helps to fight disease like diarrhea and pneumonia. In Nepal only two third of the mother exclusively breastfeed their child in the past 24 hrs. The aim of this study is to find prevalence of exclusive breastfeeding and factors influencing infant feeding practices among mothers. <br /><strong>Methods</strong><br />A cross-sectional study was conducted in Bharatpur, Chitwan among 290 lactating mothers at the Immunization Center of Bharatpur Hospital Chitwan. Mothers were interviewed on details regarding feeding of their child. <br /><strong>Results</strong><br />The mean age of the study population was 25.6 ± 4.5 years. A majority of the respondents were &lt;30 years of age (234, 82.4%), primipara (175, 61.6%) and living in a joint family (199, 70.1%). Exclusive breast feeding (EBF) was practiced by 203 (71.5%) mothers on the current infant. Low production of milk was the commonest reason for not practicing EBF (66.6%). Over two-thirds (195, 68.7%) had started breastfeeding within 1 hour of delivery. Cesarean section was the most frequent cause (71, 88.6%) for late initiation of breastfeeding. <br /><strong>Conclusions</strong> <br />The study revealed that Prevalence of Exclusive Breast Feeding is 71.5% and 93.5% of respondents had heard of EBF. Low production of milk was the commonest reason for not practicing EBF (66.6%). Still 28.5% mothers did not practice EBF, 7.7 %mothers had not heard of EBF, indicating a need for EBF promotion which could be carried out within the existing healthcare system such as the antenatal and vaccination clinics.<br /><br /></p> Srijana Panthi Pallavi Koirala Prerna Bansal Meera Prasai Kamal Khadka Ranjeeta Phyual Ayasha Shrestha Copyright (c) 2023 Srijana Panthi, Dr Pallavi Koirala, Dr. Prerna Bansal, Meera Prasai, Kamal Khadka, Ranjeeta Phyual, Ayasha Shrestha 2023-02-08 2023-02-08 18 4 348 357 10.3126/jcmsn.v18i4.49737 Clinical Evaluation of Gingival Biotype and its Association with Age and Gender among Patients Visiting a Tertiary Care Center <p><strong>Introduction</strong><br />Gingival biotype is considered as the most important prognostic factor that determines the success of periodontal therapy and somehow affects its outcome. Hence, it is crucial to identify the gingival biotype before dental treatment. This study was carried out to assess the prevalence of gingival biotypes in patients visiting a teaching hospital and evaluate its association with age and gender. <br /><strong>Methods</strong><br />This cross-sectional study was conducted from September 2021 to April 2022 amongst 225 participants from department of periodontics, Gandaki Medical College, Pokhara, Nepal. The demographic data of subjects were recorded and their gingival biotype was assessed using the probe transparency technique. <br /><strong>Results</strong><br />Among 225 participants, the majority of them (124, 55.11%) exhibited a thick gingival biotype. Thicker gingival biotype was more prevalent among age group 18 to 40 years (65, 69.15%) and greater in males (71, 77.17%) which were statistically significant (p&lt;0.001).<br /><strong>Conclusions</strong> <br />Thicker gingival biotype was more prevalent among participants in the present study. The assessment of gingival biotype of the patients can provide the knowledge to the clinician about the care to be taken while tissue handling during periodontal therapy. This in turn provides a more favorable tissue environment and maximizes the predictability of periodontal treatment. </p> Suraksha Subedi Rebicca Ranjit Soni Bista Copyright (c) 2023 Suraksha Subedi, Rebicca Ranjit, Soni Bista 2023-02-08 2023-02-08 18 4 358 364 10.3126/jcmsn.v18i4.50087 Prevalence of Abnormal Glucose Challenge Test and Oral Glucose Tolerance Test in Pregnancy <p><strong>Introduction</strong><br />Gestational Diabetes is one of the most prevalent endocrine disorders during pregnancy; associated with adverse maternal and fetal outcome. So, screening is mandatory for timely diagnosis and management. The main objective of this research is to find the prevalence of abnormal glucose challenge test and oral glucose tolerance test in pregnancy. <br /><strong>Methods</strong><br />A cross-sectional study was conducted among 480 antenatal women of 24-28 weeks gestation at College of Medical Science-Teaching Hospital Bharatpur, Nepal from Jan-Dec 2020 after ethical approval from COMS-IRC. <br /><strong>Results</strong><br />Gestational diabetes mellitus was most common in women of age group 20-30 years (62.06%). Higher percent of women with gestational diabetes were Multigravida (75.86%), high body mass index (p-value: 0.01). Fifty eight percent women with gestational diabetes had statistically significant family history of diabetes in first degree relatives (p-value 0.036). In our study, prevalence of impaired glucose challenge test was 60 (12.5%) and that of gestational diabetes mellitus was 29 (6.04%). <br /><strong>Conclusions</strong> <br />The prevalence of gestational diabetes mellitus is high with multiparity, family history of diabetes and obesity. The test is easy, cheap, feasible and patient friendly method for screening gestational diabetes mellitus.<br /><br /></p> Buddhi Kumar Shrestha Shanti Bhandari Copyright (c) 2023 buddhi kumar shrestha, Dr. Shanti Bhandari 2023-02-08 2023-02-08 18 4 365 371 10.3126/jcmsn.v18i4.51020 Procalcitonin and C-reactive Protein for Early Detection of Ventilator Associated Pneumonia in Intubated and Mechanically Ventilated Patients <p><strong>Introduction</strong><br />Ventilator associated pneumonia has very high mortality. Inadequate antimicrobial treatment is an import determinant of mortality in ventilator associated mortality. Antimicrobial treatment is usually guided by culture and sensitivity which requires at least 12 to 48 hours. In many recent studies Procalcitonin and C-reactive protein, alone or in combination, has shown a promising predictive ability to detect sepsis. The aim of this study is to find the ability of procalcitonin and C-reactive protein to predict ventilator associated pneumonia. <br /><strong>Methods</strong><br />All the mechanically ventilated patients were included except patients with AIDS, neutropenia and if the patient had procalcitonin level more than 0.6 ng/ml. All the patient had procalcitonin and C-reactive protein done daily from the day of intubation till seventh day of intubation. Broncho-alveolar aspirate sample was sent on third day of intubation. Statistical analysis was done to find sensitivity and specificity of both the biomarkers to predict ventilator-associated pneumonia. <br /><strong>Results</strong><br />C-reactive protein was high initially and decreased gradually over seven days. Procalcitonin was low and undetectable initially, highest on the third day of intubation and gradually deceased over the next following days. On the third day, Procalcitonin was found to be highly sensitive and specific to detect ventilator associated pneumonia compared to C-reactive protein. <br /><strong>Conclusions</strong> <br />Compared to C-reactive protein, procalcitonin is a good biomarkers for predicting early pneumonia in intubated and ventilated patients in ICU that can guide us in escalating antibiotics before the availability of culture and sensitivity <br /><br /></p> Rajesh Yadav Ajay Singh Thapa Rakesh Shah Hari Prasad Upadhyay Copyright (c) 2023 Rajesh Yadav 2023-02-08 2023-02-08 18 4 372 377 10.3126/jcmsn.v18i4.49689 Knowledge and Practice on Contraception among Women of Reproductive Age <p><strong>Introduction</strong><br />Family planning is a priority programme of the Government of Nepal, with more emphasis on contraception at all levels of the healthcare setting. It advocates the acceptability of contraceptive devices through distribution of Information, Education and Communication materials. Yet studies from various parts of Nepal identified the know-do gap in the use of contraception. The objective of this study was to assess the knowledge and practice of contraception among women of reproductive age of Gramthan rural municipality of Morang, Nepal. <br /><strong>Methods</strong><br />A descriptive cross-sectional study was conducted among 384 women in the 15-49 years of reproductive age group from 17 June 2022 to 17 September 2022. The consecutive sampling technique was used for data collection with a semi structured questionnaire via face to face interview. <br /><strong>Results</strong><br />The maximum number of participants were Brahmin/Chhetri 118 (30.7%). A majority (35.7%) were of 15-25 years with mean±S.D. =30.4±9.08years. All participants had heard at least one contraceptive method. The majority (80.7%) had heard about the male condoms. Only 34.4 % used family planning methods. Among them, 107(81.1%) were using temporary methods and 25(18.9%) were using permanent methods. The practice of using contraceptive devices declined with increasing age. <br /><strong>Conclusions</strong> <br />The participants had heard of at least one method of contraceptive, but very less had used any contraceptive devices. Most women were temporary method users. There was a decline in contraceptive use with increasing age.</p> Heera KC Surya Bahadur Parajuli Surakshya Bhattarai Jiba Nath Dhamala Copyright (c) 2023 Heera KC, Surya Bahadur Parajuli, Surakshya Bhattarai, Jiba Nath Dhamala 2023-02-08 2023-02-08 18 4 378 385 10.3126/jcmsn.v18i4.47893 Clinical, Radiological Profile and Bronchoscopic Assessment of Non-Resolving Pneumonia Patients in a Tertiary Care Hospital <p><strong>Introduction</strong><br />Community-Acquired Pneumonia (CAP) is one among many acute medical conditions that require hospitalisation. Majority of patients with CAP respond well to standard antimicrobial therapy while a minority (non-resolving pneumonia) fail to respond requiring further treatment. This study focuses on the clinical, radiological profile and bronchoscopic assessment of non-resolving pneumonia patients. The study also analyses the diagnostic yield of video bronchoscopy. <br /><strong>Methods</strong><br />A cross-sectional study conducted among patients admitted with non-resolving pneumonia in a tertiary care centre in the time period from August 2015 to July 2018. A total 55 patients satisfying the inclusion criteria were enrolled in the study. Clinical history, radiological assessment and video bronchoscopy were done for all patients. The variables were presented as frequency tables using SPSS-17. <br /><strong>Results</strong><br />Among the study participants, 44 patients were males while 11 were females. The majority belonged to the age group 51-60 years (38.2%). The most common clinical symptom and auscultatory finding were cough with expectoration (54%) and crackles (80%) respectively. The bronchoscopic finding was purulent secretions in majority (43.6%). BAL Cb-naat for Tuberculosis was positive in 41.8% and sensitive to rifampicin in all patients. <br /><strong>Conclusions</strong> <br />The study showed the need for early referral and evaluation of non-resolving pneumonia patients. Bronchoscopy was found to be a valid investigation modality with a good diagnostic yield.<br /><br /></p> Saravanavasan Rajendran Muthulakshmi Navaneethakrishnan Kannan Muthuraman Alagappan Copyright (c) 2023 saravanavasan Rajendran, Muthulakshmi Navaneethakrishnan, kannan muthuraman alagappan 2023-02-08 2023-02-08 18 4 386 393 10.3126/jcmsn.v18i4.49914 Clinical Outcome of the Patients Undergoing Monopolar Transurethral Resection of Prostate for Symptomatic Benign Enlargement of Prostate <p><strong>Introduction</strong><br />Benign prostatic hyperplasia (BPH) is the most common benign tumor in men. Transurethral resection of prostate (TURP) is a commonly performed urologic operation for the treatment of symptoms associated with BPH. TURP reduces lower urinary tract symptoms and also reduces the International Prostate Symptom Score (IPSS) in 94.7% cases of clinical BPH and improves quality of life in patients with BPH. The objective of this research is to analyse the clinical outcomes of patients undergoing monopolar transurethral resection of the prostate for symptomatic benign enlargement of the prostate in our center. <br /><strong>Methods</strong><br />A Retrospective cross-sectional study was conducted at the Department of Urology COMS Teaching Hospital among the patients who underwent monopolar TURP from 2019 to 2022. Patient records were collected from hospital operation books and OPD records, and further inquiry was made via phone calls. Based on the available data we analyzed the Patient's Age, Size of the prostate, Pre and post-operative IPSS, QOL score and Qmax, Operative time and complications. <br /><strong>Results</strong><br />A total of 167 patients underwent M – TURP during the study period. The mean age of patients who underwent TURP was 70.49 years. The average size of the prostate was 63.08 grams. The mean operating time was 60.09 minutes with a mean hospital stay of 5.99 days. The preoperative IPSS was 28.92, QOL was 4.72 and QMax was 9.27 and Post-operative mean IPSS, QOL score and Qmax was 5.38, 0.98 and 19.7 respectively with a p-value of less than 0.05. <br /><strong>Conclusions</strong> <br />Surgery is the mainstay of treatment in BPH if conservative and medical therapy fails. There are several endourological treatments available for BPH today, but monopolar TURP is still widely used in developing countries and is a standard treatment for BPH-related LUTS. Outcomes are comparable to other treatment modalities if done timely and meticulously.<br /><br /></p> Sudeep Raj KC Saroj giri Hari Prasad Upadhyay Bhushan Timilsina Sulav Pradhan Dipesh Kumar Kushwaha Naveen Mahaseth Copyright (c) 2023 Saroj giri, Sudeep Raj KC 2023-02-08 2023-02-08 18 4 394 399 10.3126/jcmsn.v18i4.51256 Assessment of Periodontal Status of Teeth with and without Single Fixed Prosthesis <p><strong>Introduction</strong><br />Any dental prosthesis should be compatible with existing hard and soft tissues fulfilling the necessary functional and aesthetic requirements for the longevity of periodontal health. Hence, this study was done to assess the periodontal status of teeth rehabilitated using single fixed prosthesis and compare it with their contralateral homologue. <br /><strong>Methods</strong><br />This analytical, split-mouth, cross-sectional study was conducted among patients visiting department of Periodontics, GMCTH from July 1 to February 30, 2021. The periodontal parameters (visible plaque index, gingival bleeding index, probing pocket depth, clinical attachment level) of 103 patients with single unit crown were compared with their unrestored, healthy contralateral teeth. The effect of crown material and duration of its insertion on the periodontal parameters were also assessed. The independent t-test, Mann Whitney-U test, Kruskall-Wallis test, ANOVA test were used in the study, wherever applicable.<br /><strong>Results</strong><br />All periodontal parameters of crowned teeth were found to be greater in comparison to sound teeth which was statistically significant (p&lt;0.001). The duration of crown placement did not have significant effect on periodontal health. Mean visible plaque index, probing depth and clinical attachment level were greater in all metal crown followed by metal ceramic crown and all ceramic crowns having the least values, which was statistically significant (p&lt;0.001).<br /><strong>Conclusions</strong> <br />Crowned teeth had significantly larger amount of supragingival plaque, increased gingival bleeding, deeper pocket depths and greater clinical attachment loss than sound teeth. Thus, an adequate periodontal assessment and treatment, when planning a prosthodontic rehabilitation, can limit or avoid any potential detrimental effects on periodontium. </p> Rebicca Ranjit Pratik Manandhar Soni Bista Suraksha Subedi Copyright (c) 2022 Rebicca Ranjit, Pratik Manandhar, Soni Bista, Suraksha Subedi 2023-02-08 2023-02-08 18 4 400 408 10.3126/jcmsn.v18i4.48642 Airway Evaluation to Predict Difficult Laryngoscopy: Evaluation of Routine Parameters and Defining the Cutoff Value for Skin to Epiglottis Distance in Nepalese Population <p><strong>Introduction</strong><br />Anesthesiologist is responsible for securing a continuously patent airway, failure to do so within critical minitues results in hypoxic consequences. It is essential to able to predict difficult laryngoscopy and intubation for which conventional airway examinations for relied upon. These conventional airway examinations have been found not to be hundred percent sensitive or specific and have found to have high inter observer variability. In such context and in the absence of adequate datas on Nepalese population, this study was conducted to aid to the data of airway examination parameters in Nepalese population and to find the place of ultrasonography in preanesthesia airway examination. Aim: To evaluate different preanesthesia airway examination parameters and to find the cutoff value of skin to epiglottis distance. <br /><strong>Methods</strong><br />The study included all 120 cases posted for elective surgeries. All the patients underwent preanesthesia airway examination and the parameters were noted by one anesthesiologist. All the patients also underwent ultrasonography of airway and skin to epiglottis distance was measured and noted by another anesthesiologists. All the patients underwent surgery under general anesthesia after laryngoscopy and intubation. The observed parameters and skin to epiglottis distance were used for statistical analysis.<br /><strong>Results</strong><br />Prevalence of difficult intubation was 9.4%. Conventional airway examination parameters were observed to be very less sensitive and have less positive predictive value but the specificity and negative predictive value were high. Thyromental distance was observed to have highest sensitivity of 65% and sternomental distance was observed to highest specificity of 96.5%. In difficult intubation group, the mean of skin to epiglottis distance was 16.57±0.97 mm and the calculated cutoff value was 14.63 mm. <br /><strong>Conclusions</strong> <br />Prevalence of Laryngoscopy difficult is high. he conventional airway examination tests are useful but may not be totally relied upon and ultrasonography can be a helpful aid. </p> Ajay Singh Thapa Rajesh Kumar Yadav Rakesh Shah Anish Bhattarai Copyright (c) 2023 Ajay Singh Thapa 2023-02-08 2023-02-08 18 4 409 414 10.3126/jcmsn.v18i4.49558 Prevalence of Adverse Drug Reactions of Anti-Hypertensive Drugs in A Tertiary Care Hospital, Bhairahawa, Nepal <p><strong>Introduction</strong><br />Hypertension represents the common disease worldwide which mostly requires long-term therapy and combination of two or more antihypertensive drugs. These drugs are frequently linked to adverse drug reactions. The objective of the study was to determine the prevalence of adverse drug reactions in patients under anti-hypertensive drugs. <br /><strong>Methods</strong><br />The study was a cross-sectional study conducted among 250 hypertensive patients under medications at the medicine department of Universal College of Medical Sciences- Teaching Hospital. Face-to-face interviews were used to gather the data, which was then recorded on an adverse medication reaction monitoring form. Naranjo algorithm scale was used to categorize the causality relationship of adverse drug reactions. <br /><strong>Results</strong><br />Out of 250 hypertensive patients, a total of 73 ADR cases (29.2%) were observed. The most commonly linked drugs with ADRs were calcium channel blockers (65.8%) followed by ARBs (12.3%), Beta-blockers (9.6%) and Diuretics (6.8%). Amlodipine (62.9%) was found to be the most frequently linked drug to ADR. Most of the ADRs in the current study fell under category possible (38.3%) followed by definite (28.8%), probable (21.9%) and doubtful (11%) respectively. <br /><strong>Conclusions</strong> <br />Patients taking anti-hypertensive drugs commonly experience adverse drug reactions. The study recommends that ADR monitoring be conducted continually in hospital settings in order to identify and document any adverse effects brought on by various drugs so that it would be helpful for doctors to rationally prescribe.<br /><br /></p> Anjan Palikhey Ramita Chaudhary Laxmi Shrestha Amit Kumar Shrivastava Chandrajeet Kumar Yadav Anish Giri Ajit Kumar Sah Jharana Shrestha Copyright (c) 2023 Anjan Palikhey, Ramita Chaudhary, Laxmi Shrestha , Amit Kumar Shrivastava , Chandrajeet Kumar Yadav, Anish Giri, Ajit Kumar Sah, Jharana Shrestha 2023-02-08 2023-02-08 18 4 415 421 10.3126/jcmsn.v18i4.51061 Comparison of Spot Vision Screener and Retinoscopy for Detecting Refractive Errors in Children and Adults in a Tertiary Care Eye Hospital <p><strong>Introduction</strong><br />Hand held photoscreeners are found to be useful for detecting significant refractive error and amblyopic risk factors in very young, preverbal and children with disabilities. Our study aims to determine the accuracy of spot vision screener compared to retinoscopy in screening refractive errors in both children and adults. <br /><strong>Methods</strong><br />A total 388 eyes of 194 patients, 113 adults and 81 children underwent refractive error measurement through retinoscopy and spot vision screeners. Comparison of the findings of dry retinoscopy and spot vision was done for both adults and children. Cycloplegic comparison was done for children. Bland-Altman analysis was done to determine the limit of agreement between the measurements of two methods. <br /><strong>Results</strong><br />The mean difference in spherical equivalent between spot vision screener and dry retinoscopy among both eyes of 113 adults was 0.08±0.18D. Among both eyes of 81children administered non-cycloplegic refraction the mean difference was 0.19±0.28D.A total of 25 children had both dry and wet refraction; among these children the mean difference before cycloplegia was 0.25±0.21D and the mean difference after cycloplegia was 0.05±0.40D. Bland-Altman analysis showed a good agreement between both methods in adults and children. <br /><strong>Conclusions</strong> <br />The spot vision screener showed no significant difference both clinically and statistically in both adults and children, with more accurate in children after cycloplegia. Spot vision screener can be used as a tool for screening refractive errors, but still retinoscopy with subjective refinement should be considered as the gold standard for refractive error correction.</p> Sangita Sharma Bhandari Gopal Bhandari Gaurav Kumar Bhardwaj Manisha Shrestha Ankita Adhikari Jeremy Keenan Copyright (c) 2023 Dr. Sangita Sharma Bhandari, Gopal Bhandari, Gaurav Kumar Bhardwaj, Manisha Shrestha, Ankita Adhikari, Jeremy Keenan 2023-02-08 2023-02-08 18 4 422 431 Universal Screening for Hypothyroidism in 1st Trimester of Pregnancy: Where are We for Subclinical Hypothyroidism? <p><strong>Introduction</strong><br />Subclinical hypothyroidism is missed to diagnose until fetal/maternal complications supervene and yet treatable if diagnose in 1st trimester. High disease prevalence and adverse pregnancy outcome concerns its timely identification &amp; treatment to prevent, decrease or reverse the forthcoming complications. The objective of this research is to find prevalence of Subclinical hypothyroidism estimating TSH as 1st line test. <br /><strong>Methods</strong><br />It was a descriptive cross sectional study. Sample size consisted of 153 pregnant women attending antenatal clinic &amp; wards. TSH assessment was done at 1st visit along with antenatal testing. If TSH is ≥4mIu/ml (ATA) and ≥2.5mIU/ml (Iodine deficit area), freeT4 and thyroid perioxidase antibody test (anti-TPO) was further analyzed. Data was analyzed by using SPSS-20. <br /><strong>Results</strong><br />A study was conducted among 153 pregnant women during their 1st trimester in the department of Obstetrics and Gynecology, College of Medical Sciences, Bharatpur, Nepal. The mean ±SD age was 26.1 ±4.38 years, mean ±SD gestational age was 7.6±1.35 weeks and mean ±SD body mass index (BMI) was 23.1±2.46. Thirteen percent subjects had TSH ≥4 mIU/L &amp; 35% had TSH≥2.5mIU/ml above the cutoff used for definition of hypothyroidism. Anti Thyroid perioxidase (Anti-TPO) test positive were 47.6% (TSH≥4mIU/ml) <br /><strong>Conclusions</strong> <br />Subclinical hypothyroidism is highly prevalent in population visiting our hospital, so a universal screening with TSH estimation will be cost worthy in our area to intervene early before feto/maternal complications supervene.</p> Subha Shrestha Buddhi Kumar Shrestha Manisha Acharya Puja Baniya Bhagirathi Kayastha Sabin Lamsal Prateek Lekhak Praju Khatiwada Copyright (c) 2023 Dr. Subha Shrestha, Dr.Buddhi Kumar Shrestha, Dr.Manisha Acharya, Dr.Puja Baniya, Dr. Bhagirathi Kayastha, Dr. Sabin Lamsal, Dr. Prateek Lekhak, Dr. Praju Khatiwada 2023-02-08 2023-02-08 18 4 432 439 10.3126/jcmsn.v18i4.49041