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> en-US (Dr. Dipendra Khatiwada) (Sioux Cumming) Sun, 31 Dec 2023 09:50:17 +0000 OJS 60 Blood Pressure and Hematoma Expansion in Hemorrhagic Stroke <p><strong>Introduction</strong><br />Hematoma expansion after hemorrhagic stroke can lead to devastating consequences. An important factor associated with this is high blood pressure. This study was carried out to find out what proportion of patients with hemorrhagic stroke develop hematoma expansion and whether blood pressure during presentation could be associated with it.<br /><strong>Methods</strong><br />This prospective observational study was carried out over a period of one year in patients who were admitted with the diagnosis of hemorrhagic stroke. The collected data were entered into and analyzed by using the Statistical Package for the Social Sciences version 26 after obtaining approval from the Institutional Review Committee of the Institute of Medicine, Tribhuvan University. <br /><strong>Results</strong><br />Out of 83 patients included in the study, history of hypertension was present in 72 (86.7%). Hematoma expansion occurred in 11 (13.3%). There was no statistically significant associations between mean systolic, diastolic, and mean blood pressures between patients with and without hematoma expansion [(168.9±35.6, 164.5±28.5, t(81)=0.47, p=0.64), (101.8±18.9, 101.2±19.6, t(81)=0.10, p=0.92) and (124.2±23.6, 122.3±21.5, t(81)=0.27, p=0.79) respectively (values in mmHg)]. Majority of patients with hematoma expansion had high absolute systolic blood pressure (27.3% vs 26.4%) and high absolute diastolic blood pressure (54.5% vs 38.9%); however, the associations were not statistically significant (p= 1.00 and 0.33 respectively).<br /><strong>Conclusions</strong> <br />High blood pressure is highly prevalent but hematoma expansion is not common in patients with hemorrhagic stroke. There was no statistically significant association between history of hypertension, gender, patient age, absolute and mean blood pressures, and hematoma expansion in our study.</p> Bikram Prasad Gajurel, Pukar Ghimire, Pradeep Panthee, Sumit Shahi, Rajeev Ojha, Reema Rajbhandari, Ragesh Karn Copyright (c) 2023 Bikram Prasad Gajurel, Pukar Ghimire, Pradeep Panthee, Sumit Shahi, Rajeev Ojha, Reema Rajbhandari, Ragesh Karn Sun, 31 Dec 2023 00:00:00 +0000 Antibiotics Prescribing Pattern of Outpatients in a Tertiary Level Hospital in Nepal <p><strong>Introduction. </strong>Antibiotics are most abundantly used drugs of major global concern for rapid ongoing emergence of resistant strains, increase overall cost of treatment and impact on national economy. Optimized use of antibiotic on the basis of proper diagnosis, prescriber’s attention about the problem and antimicrobial stewardship programs may become a way to rationalize the use.</p> <p><strong>Methods. </strong>This is a cross-sectional descriptive study done in patients visiting to various OPD of tertiary referral hospital. Prescriptions were randomly selected and Antibiotics utilization was assessed by WHO prescribing Indicator form. Prescribed drugs were checked for adherence to guidelines and essential medicine list.</p> <p><strong>Results. </strong>Among 731 sampled prescriptions, 384 (52.53%) were found with at least one antibiotic; 214 prescriptions (55.72%) were of female patients. Mean age was 37.71 years with SD 25.01. Highest numbers of patients (21.09%) belong to the 15-29 age group. &nbsp;Highest number of patients 158 (41.15%) treated with antibiotics were seen in patient attending Medicine department, 30 antibiotics were prescribed for 577 times. Amoxicillin-Clavulanate 70 (12.13%) was the most frequently prescribed followed by Azithromycin and Metronidazole with frequency of 39 (6.76%). Drug availability is 50.36%, in the facility and only 2.4 % of drugs were prescribed in generic.</p> <p><strong>Conclusions.</strong> More than half of the patients were prescribed with antibiotics and all antibiotics were prescribed empirically. Newer generation antibiotics with broad spectrum efficacy were used in remarkable frequency. This study provides evidence for antibiotic stewardship, drug use review and establishment of institutional guidelines.</p> Kalyan Sapkota, Deviram Pokharel, Shailesh Basel, Bijaya Dhakal Copyright (c) 2023 Kalyan Sapkota, Deviram Pokharel, Shailesh Basel, Bijaya Dhakal Sun, 31 Dec 2023 00:00:00 +0000 Retrograde Intrarenal Surgery versus Mini-Percutaneous Nephrolithotomy for Lower Calyceal Stones of ≤ 2 cm <p><strong>Introduction: </strong>Renal stones are one of the common urological problems. The optimal management of lower calyceal renal calculi of 1-2 cm is still debatable. The objective of this research is to assess the safety, efficacy, and stone-free rate of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for the management of lower calyceal stones of 1-2 cm.</p> <p><strong>Methods: </strong>A prospective comparative study was conducted among 30 patients which were divided in two group (A and B) prospectively with lower calyceal stones of 1-2 cm. Group A were treated with retrograde intra renal surgery while Group B were treated with mini percutaneous nephrolithotomy.</p> <p><strong>Results: </strong>The mean age of patient in Group-A was 44.27±17.10 year and in Group-B was 45.27±16.11 year. The hospital stay in Group-A was 3.47±0.62 and in Group-B was 4.50±0.73 days. The stone size in Group-A was 13.30±2.21 mm and in Group-B was 15.60±2.55 with p-value of 0.381. The duration of operation time in Group-A was79.37±13.96 minutes and in Group-B was 62.53±7.41 minutes with p value of 0.091.</p> <p><strong>Conclusions: </strong>Both retrograde intrarenal surgery and mini-percutaneous nephrolithotomy procedure are comparable. Mini percutaneous nephrolithotomy has a better stone free rate and haematuria is more common but retrograde intrarenal surgery has less hospital stay and post operative pyrexia is more common.</p> <p> </p> Rajiv Shah, Tika Devi Kandel, Deepak Adhikari Copyright (c) 2023 Rajiv Shah, Tika, Deepak Sun, 31 Dec 2023 00:00:00 +0000 Prevalence and Variations of Sesamoid Bones in the Hands of Patients Visiting Teaching Hospital of Kaski District: A Retrospective Study <p><strong>Introduction</strong>: Sesamoids are small, well-corticated, ovoid or nodular, may be bipartite ormultipartite bones/ossifications found close to a bone or a joint that are subject to significant morphological variations. Although it is difficult to determine the symptomatic nature of these bones, imaging provides important diagnostic information. The objective of this study is to assess the prevalence and variations of sesamoid bone in hands of patients visiting a teaching hospital of Kaski district.</p> <p><strong>Methods:</strong> A hospital based retrospective cross-sectional study was conducted by analyzing X-rays of hand with Anteroposterior (AP) view, a total of 150 both male and female patients between the age group of 18 to 85 wereimaged between August 1, 2022 to December 30, 2022 at Department of Radiology &amp; Imaging(X-Ray Unit). Presence of sesamoid bone of hand was noted on 1<sup>st</sup>, 2<sup>nd</sup>, 3<sup>rd</sup>, 4<sup>th</sup> and 5<sup>th</sup> metacarpophalangeal joints (MCPj), and the 1<sup>st</sup> interphalangeal joint (IPj), separately. The data were analyzed for correlation using Pearson’s correlation test.&nbsp; Ethical approval was taken from the Institutional Review Committee of Gandaki Medical College (Reference No.159/079/080).</p> <p><strong>Results:</strong> The prevalence of sesamoid bone at 1<sup>st</sup>, 2<sup>nd</sup>, 3<sup>rd</sup>, 4<sup>th</sup> and 5<sup>th</sup> MCPj, and 1<sup>st</sup> IPj were 100 (100%), 60 (46%), 24(16%), 20(13.3%), 100(66.7%), and 114(76%) respectively. Variation was more prominent among females at 2<sup>nd</sup>, 3<sup>rd</sup>and 5<sup>th</sup> MCPj and 1<sup>st</sup> IPj, Also, SB variation was more prominent on left hand compared to right hand in 2<sup>nd</sup>, 4<sup>th</sup>and 5<sup>th</sup> MCPj and 1<sup>st</sup> IPj.</p> <p><strong>Conclusions:</strong>No significant correlation between the gender and laterality with presence or absence of SB in the hands were noted.</p> Sushma Singh, Pujan Sharma, Bhoj Raj Sharma, Kanchan Kumari Barnawal Copyright (c) 2023 Sushma Singh Sun, 31 Dec 2023 00:00:00 +0000 Efficacy of Silver Diamine Fluoride in Arresting Dental Caries in Primary Teeth in Patient Visiting Tertiary Hospital of Kathmandu <p><strong>Introduction</strong><br />Carious lesions can both be prevented and arrested using fluoride-based materials. This study was done to evaluate and compare the efficacy of silver diamine fluoride in arresting dental caries at different frequencies of applications.</p> <p><strong>Methods</strong><br />This experimental study was conducted among ten preschool children of 3-5 years old with seventy-four active carious lesions taking teeth as a sample unit. Children were randomly allocated into two intervention groups: Group 1— application of 38% silver diamine fluoride solution atthree consecutive weeks and Group 2— three applications of 38% silver diamine fluoride solution at monthly interval. The time taken of caries arrest was recorded. Data were collected and entered in Microsoft Excel sheet and analysis was done in Statistical Package for the Social Sciences (SPSS) version 16. <br /><strong>Results</strong><br />The mean time taken for caries arrest for Group II (57.20 days) was found to be statistically longer than Group I (21.54 days) (p-value &lt; 0.001). As the mean time taken for caries arrest for Group I was shorter, the weekly application was found to have higher efficacy than the monthly application. <br /><strong>Conclusions</strong><br />Efficacy of Silver Diamine Fluoride was found to be more in Group I (weekly application) compared to Group II (monthly application).</p> Namrata Gyawali, Sunanda Sundas , Barun Kumar Sah, Neha Dhakal Copyright (c) 2023 Namrata Gyawali, Dr. Sunanda Sundas , Barun Sah, Neha Dhakal Sun, 31 Dec 2023 00:00:00 +0000 Knowledge and Awareness regarding Strabismus and Amblyopia among School Nurses and Primary School Teachers of Government Schools at Bharatpur <p><strong>Background</strong></p> <p>Strabismus/squint is an ocular misalignment in which the eyes are not properly aligned with each other. Amblyopia is a serious visual impairment resulting from abnormal visual stimulation during early childhood. It can be easily prevented or treated if detected early. This study aimed to assess the knowledge and attitude of school nurses and primary school teachers of Government schools toward children suffering from strabismus and amblyopia.</p> <p><strong>Method</strong></p> <p>This was a cross-sectional study among the participating school nurses and primary school teachers of Government school which was organized to raise awareness regarding strabismus and amblyopia among them. It was conducted using a questionnaire which contained 22 items divided into three sections. First section consisted of demographic parameters, second regarding knowledge of strabismus and the third the knowledge of Amblyopia. Data were analysed using Epi info version 7.02 (Centers for Disease Control, Atlanta, Georgia, United States). P-values of &lt;0.05 was used for clinical significance.</p> <p><strong>Result</strong></p> <p>There were 67 participants and the mean age was 32.67±7.71 years, range 21 to 55 years, the majority being female 66 (98.51%). Training on eye health was received by 13 (19.40%). Forty-four (65.67%) participants had knowledge of strabismus and amblyopia, out of them 30 were school nurses. The majority of school nurses 23 (76.67%) and primary teachers 13 (92.86%) had good knowledge scores (6 to 10).</p> <p><strong>&nbsp;</strong><strong>Conclusion</strong></p> <p>The majority of participants had good knowledge about strabismus and amblyopia. As the school nurses and primary school teachers are the first link to the children at risk, improving their awareness level on strabismus and amblyopia will help in early referral, timely intervention and prevent the risk of vision loss.</p> <p>&nbsp;</p> Manisha Shrestha Copyright (c) 2023 Manisha Shrestha Sun, 31 Dec 2023 00:00:00 +0000 Clinicoepidemiological Profile of Agricultural Work Related Injuries in Rural Agrarian Community of Nepal: A Cross Sectional Study <p><strong>Introduction</strong></p> <p>Injuries have a significant proportion in the global burden of diseases and are in increasing trend. Nepal being an agrarian country had frequent reporting of injuries among rural communities whose major occupation is agriculture. So, we had this study with the objective to assess clinico epidemiological profile of agricultural work related injuries in the rural agrarian community of Nepal.</p> <p><strong>Methods</strong></p> <p>A community based cross sectional study was conducted among 362 farmers of rural agrarian communities of Budhiganga Rural Municipality of Nepal from 20 December 2022 to 20 June 2023 after getting ethical clearance from institutional review committee (IRC-PA 254/2022). A specially designed pro forma was used to collect data through convenient sampling techniques. Collected data was entered in Microsoft Excel and analyzed by SPSS version 23.</p> <p><strong>Results</strong></p> <p>The annual prevalence of agricultural work related injury was 48.6%. The most common primary causes were Sickle cut injury 43(24.4%), followed by Oxen/Cow hit injury 33 (18.8%), Traditional Plough cut injury 15 (8.5%), Spade cut injury 15 (8.5%) etc. Injury typically occurs in lower extremities 71 (40.3%). <strong> </strong>Among them 102 (58%), 82 (46.6%), 28 (15.9%) and 147 (83.5%) had a disability, bedridden, hospitalized and received some sort of treatment. Twenty two (12.5%), 36 (20.5%) and 32 (18.2%) reported stress, self reported decreased vision and self reported hearing loss at the time of injury respectively. Only 9 (5.1%) had used personal protective equipment (PPE) during agricultural work and about 36 (20.5%) had helping hands at the time of injury. </p> <p><strong>Conclusions</strong></p> <p>About half of farmers experienced agricultural work related injury with significant days of disability from daily activities and regular work. Use of personal protective equipment during work is miserable.</p> Surya Bahadur Parajuli, Heera KC, Bikki Shah, Hom Bahadur Parajuli, Binod Kumar Yadav Copyright (c) 2023 Dr Surya Bahadur Parajuli, Heera KC, Dr Bikki Shah, Hom Bahadur Parajuli, Dr Binod Kumar Yadav Sun, 31 Dec 2023 00:00:00 +0000 Health Insurance Utilization Pattern among Community People of Jutpani Kalika Municipality of Chitwan Nepal <p><strong>Introduction</strong><br />The Government of Nepal's Social Health Security Scheme (SHSS) is a social protection program that strives to give its inhabitants access to high-quality medical treatment without putting a financial burden on them. As a way of achieving Universal Health Coverage, this program makes an effort to overcome obstacles to utilizing health services and assure equity and access for underprivileged and poor populations. Thus, the study aimed to assess the pattern of using health Insurance Schemes by the community people of Central Nepal.</p> <p><strong>Methods</strong><br />A cross-sectional, descriptive, prospective study was conducted at Jutpani Kalika Nagar Palika ward No 7. A total of 274 enrolled households were taken using a non-probability, convenient sampling technique. The sample size was calculated by using the formula(n)= z 2pq/e2. Specifically designed proforma were used to assess the pattern of utilizing health insurance schemes. The collected data was entered in SPSS version 16. Descriptive analysis and Chi-square was applied.</p> <p><strong>Results</strong><br />Among 274 enrolled households, 94.9% have utilized the Social Health Security Scheme (SHSS). Among the study participants, 60.9% had utilized SHSS for laboratory services. The majority of study participants 230(94.7%) were below the poverty line and were utilizing SHSS. The education of the head of the household and the number of earning members in the family were found significantly associated with the utilization of SHSS.</p> <p><strong>Conclusions</strong> <br />The majority of people were utilizing SHSS and they were willing to continue this program and study found that people have faith in government service.</p> Srijana Panthi, Suman Lohani, Alisha Manandhar, Prerna Bansal, Aayasha Shrestha, Meera Prasai Copyright (c) 2023 Srijana Panthi Sun, 31 Dec 2023 00:00:00 +0000 Parental Satisfaction Regarding Online Education of Their Children During COVID-19 Pandemic <p><strong>Introduction</strong><br />COVID-19 has emerged as a pandemic and started online education. Online education can play a vital role in the process of teaching and learning and parental satisfaction is extremely important in effective implementation of the online education in their children, especially at homes where newly adopted during COVID-19.The purpose of this study was to assess the parental satisfactions regarding online education of their children during COVID-19 pandemic.</p> <p><strong>Methods</strong><br />This descriptive cross-sectional study was conducted from21st August 2021 to 25th January 2022 in a Phoolbari 11, Pokhara. Ethical approval was taken from the Gandaki Medical College Institutional Review Committee. Purposive sampling method was used. The data were collected using a questionnaire through face to face interview whose children had participated in online education.</p> <p><strong>Results</strong><br />Out of 216 respondents, the study revealed that more than half of the respondents (52.8%) had low satisfaction. The highest satisfaction experienced by parents was social interaction (11.98±2.88) followed by instructional support (14.97±3.11). There was significant association between level of satisfaction with parental sex (p=&lt;0.002), parents’ education (p&lt;0.001), parents’ occupation (p=&lt;0.005), monthly income (p=&lt;0.011) and status of living (p=&lt;0.020). Likewise, there was significant association between level of satisfaction with child sex (p&lt;0.001), fast internet at home for online learning (p=&lt;0.001) and children participate in online class with laptop/tab/mobile phone (p&lt;0.001).</p> <p><strong>Conclusions</strong> <br />It is concluded that respondents have low level of satisfaction. Therefore, intervention for increasing satisfaction should be conducted by the concerned authority.</p> Harikala Soti, Nitu Kumari Singh, Indu Sah, Laxmi Paudyal Copyright (c) 2023 harikala soti Sun, 31 Dec 2023 00:00:00 +0000 Prospective Comparative Study of Above Elbow Cast for Six Weeks Versus Above Elbow Converted to Below Elbow Cast After Three Weeks for Pediatrics Distal Forearm Fracture <p><strong>Introduction</strong><br />Forearm fractures are common injuries and the approach to manage these in children is different than similar injuries in adults. Various methods of cast immobilization are done for the treatment of distal forearm fractures in children. The purpose of this study was to determine if above elbow cast (AEC) converted to below elbow cast (BEC) in three weeks are as effective as above elbow cast (AEC) in the treatment of the distal forearm fracture. Therefore, this study was conducted with the objective of evaluating and comparing the outcome of above elbow cast (AEC) with above elbow converted to below elbow cast (BEC) after three weeks for management of pediatrics distal forearm fracture.</p> <p><strong>Methods</strong><br />This study was conducted in Department of Orthopedic Surgery in College of Medical Sciences-TH Bharatpur, Nepal from February 2016 to January 2017. Among sixty cases thirty were selected in AEC group and thirty in above elbow converted to below elbow cast group (AEC/BEC) by simple random sampling. All patients were followed up six months.</p> <p><strong>Results</strong><br />Out of sixty patients in two groups, fifty-three made to all follow up. Twenty- eight of cases were AEC group and twenty-five were AEC/BEC group. All the cases had union at six weeks and twelve weeks follow up. There was statistically significant difference in limitation in pronation/supination.</p> <p><strong>Conclusions</strong> <br />AEC converted to BEC for six weeks is effective as AEC for six weeks in the treatment of distal third forearm fracture in children. AEC/BEC group patients have lesser degree of loss of supination/pronation movement.</p> Saugat KC, Hemant Kumar Gupta, Raj Kumar Hamal Copyright (c) 2023 Saugat KC Sun, 31 Dec 2023 00:00:00 +0000 Prevalence and Associated Factors of Depression among Perimenopausal Women of Tokha Municipality, Kathmandu <p><strong>Introduction</strong><br />Depression is common among all population but even more in women going through menopause. It is due to hormonal changes during that period paired with certain behavioral as well as biological factors and even certain life events that can have devastating effects on the person. The objective of this research is to find the prevalence and associated factor of perimenopausal depression along with factors associated with it.</p> <p><strong>Methods</strong><br />A Cross sectional descriptive study was conducted in Ward no. 10 and 11 of Tokha Municipality among 205 perimenopausal women. Permission was taken from Research department of National Open College also from the ward offices of Tokha Municipality, Kathmandu. The collected data was entered in Microsoft excel and analyzed in SPSS version 22.</p> <p><strong>Results</strong><br />The prevalence of depression among perimenopausal women was more than one-third (39.2%), 28.7% of respondents having mild depression, 8.3% having moderate depression, 1.1% having moderately severe and 1.1% having severe depression. Depression was found to have significant association with loss of family members or peers and help seeking intention of the respondents.</p> <p><strong>Conclusions</strong> <br />The study identified prevalence of depression among perimenopausal women. Loss of closed ones and help seeking intentions were seen to be associated with depression during perimenopause. </p> Sriyansu Piya, Bijay Lal Pradhan, Hari Prasad Upadhyay Copyright (c) 2023 Hari Prasad Upadhyay, Bijay Lal Pradhan Sun, 31 Dec 2023 00:00:00 +0000 Histopathological Spectrum of Pigmented Skin Lesions in a Tertiary Care Centre of Nepal <p><strong>Introduction</strong><br />Pigmented skin lesions are defined as altered pigmentation of the skin as well as mucous membrane which can present as flat or raised growth and can be blue, brown, black or grey in color. The main aim of the study was to see the histopathological spectrum of pigmented skin disease and compare the clinical and histopathological diagnoses.</p> <p><strong>Methods</strong><br />It is observational cross-sectional study conducted in the Department of Pathology of Gandaki Medical College and Teaching hospital from January 2022 to December 2022 and 80 cases were included.</p> <p><strong>Results</strong><br />Age of the patient ranged from seven to 89 years and mean ± SD was 49.55 ± 21.73 years. There were 34 (42.6%) males and 46 (57.4%) females with a female: male ratio 1.3:1. The most common site of distribution of pigmented lesions of the skin were face in 44(55%) followed by trunk in 15(18.7%), extremities in 13(16.2%), scalp in 7(8.8%) and genitalia in 1 (1.3%). Histopathological study revealed the most common lesion as melanocytic nevi 14(17%) followed by basal cell carcinoma 11(13.8%), seborrheic keratosis 6(7.6%), Keratoacanthoma 5(6.3%), verrucous epidermal nevus 4(5%) and others cases in few numbers. Clinicopathological agreement was seen in 44 (55%).</p> <p><strong>Conclusions</strong> <br />Melanocytic nevi were the most common among the pigmented skin lesion. Other causes of pigmented lesions were due to keratinocytic, vascular and reactive changes. Malignant tumors can sometimes mimic benign lesions. Therefore, histopathological examination remains the gold standard in diagnosing these conditions and provide proper guidance for further management of patients.</p> Sunita Ranabhat, Suman Poudel, Gita Pun Copyright (c) 2023 Sunita Ranabhat Sun, 31 Dec 2023 00:00:00 +0000 Outcome of Medial Plating for Fracture Shaft of Humerus <p><strong>Introduction</strong><br />Fracture shaft of humerus is commonly seen fracture which is managed by nonoperative and operative methods. Operative fixation allows early return to daily work with ease in rehabilitation and less complication. This study was conducted to evaluate outcome of fracture shaft of humerus treated with plating by anteromedial approach on medial surface of humerus.</p> <p><strong>Methods</strong><br />A hospital based prospective study including 164 cases of humerus fracture shaft surgically managed with medial plating over a period 15th July 2017 to 14thJune 2022with the mean follow-up duration of 24 weeks was performed. The final outcome was evaluated on the basis of radiological union and Modified Stewart and Hundley Scoring criteria.</p> <p><strong>Results</strong><br />Fracture united in 49.39% of cases within 12 weeks, 28.65% case united in 12-24 weeks time and 19.61% cases united later than 24 weeks. Non union seen in 4 cases in our study treated with bone grafting healed. Functional outcome was measured as per Modified Stewart and Hundley Scoringcriteria, it was excellent in 67.08% of cases, good in 18.29%, satisfactory in 7.93 % of cases. Poor results were seen in 6.7 percent of cases.</p> <p><strong>Conclusions</strong> <br />Anterolateral approach with medial plating was found to be better option for fixation of fracture shaft of humerus as per our study as it has fewer complication with comparable results to other literature.</p> Hemant Kumar Gupta, Rajkumar Ravi Hamal, Suman Lamichhane Copyright (c) 2023 Hemant Kumar Gupta Sun, 31 Dec 2023 00:00:00 +0000 Skeletal, Dental and Soft Tissue Effects of Twin Block Appliance in Different Facial Divergence Cases <p><strong>Introduction</strong><br />Class II malocclusions refer to a discrepancy in the sagittal plane associated with either backward or upward rotation of the jaw. A backwardly positioned mandible is usually managed using a Twin block appliance which contains a bite plane to direct the occlusal forces in a more favorable direction. Our aim was to evaluate skeletal, dental, and soft tissue changes using twin-block appliance therapy in different facial divergence patients.</p> <p><strong>Methods</strong><br />A cephalometric study was conducted among two groups with 15 patients in each group. Group 1 have a Frankfort Mandibular plane Angle (FMA) of 18-25 degree while Group 2 have an FMA of 28 to 33 degree with Class II Division I malocclusion. All of them were treated with twin block appliances with modifications done according to FMA. Cephalometric analysis was done using Dolphin software (Dolphin Imaging 11.95) to evaluate skeletal, dental, and soft tissue changes after twin block therapy.</p> <p><strong>Results</strong><br />Analysis of variance and paired t-test were used to evaluate pre and post-treatment changes in cephalograms. The position of the mandible, maxillomandibular relation, and mandibular length was changed by 3.99 degrees, 5.23 degrees, and 4.04mm respectively in horizontal growers, while by 2.9 degrees, 1.74 degrees, and 1.07mm respectively in vertical growers. An increment in FMA by 4.59 degrees in horizontal growers with good vertical control and a little increment in FMA by 1.07 degrees in vertical growers were seen.</p> <p><strong>Conclusions</strong> <br />The twin block appliance is effective in skeletal, dental, and soft tissue correction in patients with different facial divergences.</p> Kanistika Jha, Manoj Adhikari, Pratikshya Panthee Copyright (c) 2023 Kanistika Jha, Manoj Adhikari, Pratikshya Panthee Sun, 31 Dec 2023 00:00:00 +0000 Potential Nephrotoxic Sequel of the Kidney Following Exposure to Turmeric Extract in Adult Wistar Rats <p><strong>Introduction</strong><br />Turmeric (<em>Curcuma Longa</em>) is a rhizomatous, perennial plant, flowering in nature, belonging to the ginger family. It’s potential therapeutic benefits, has led to an increase in its consumption globally. Despite severe studies on turmeric there is still existing literature gap on the effect of turmeric on the kidney. This study espoused the potential nephrotoxic sequel of the kidney following exposure to turmeric extract in adult wistar rats.</p> <p><strong>Methods</strong><br />Ethical approval for the study was obtained from the Ethics and Research Committee in the Faculty of Basic Medical Sciences of the Delta State University, Abraka. 24 adult female Wistar rats, weighing between 180g - 200g were used as experimental model. They were grouped into 4 groups (A, B, C and D), and were euthanized at the end of the experimental days and effect of tumeric extract were studied.</p> <p><strong>Results</strong><br />We found that tumeric extract effect on the kidney histology was unremarkable in all groups with varying doses. Also observed was moderate significant increase in creatinine and urea level in treated groups when compared with control group.</p> <p><strong>Conclusions</strong> <br />Obtained upshot suggests that oral administration of turmeric with graded doses and time dependent showed no microscopic or cytoarchitectural changes, but with a negative functional report. </p> Efe Ahama, Vincent-Junior Onoriode Igben, Joseph Ubogu, Ignatius Osakue Ifechukwude, Udoka Shalom Nwabuoku, Promise Okwuribo, Aghogho Kpangban, Igho Emmanuel Odokuma Copyright (c) 2023 Efe Ahama, Vincent Igben, Shalom Nwabuoku, Promise Okwuribo, Aghogho Kpangban Sun, 31 Dec 2023 00:00:00 +0000 Analysis of Ear, Nose, Throat and Head & Neck Surgery Consultations and Diagnostic Accuracy in a Tertiary Care Hospital of Western Nepal <p><strong>Introduction</strong><br />ENT cases are very common accounting for 25-40% of all hospital patient. Subspecialty consultations are a necessary part of comprehensive medical care that provide an opportunity for interactions between doctors and the exchange of knowledge and expertise that helps in quality patient management.</p> <p><strong>Methods</strong><br />A descriptive cross-sectional study was conducted among patients asked for consultation in the Department of ENT and Head &amp; Neck Surgery, Manipal Teaching Hospital from March 2022 to November 2022. Diagnosis made by ENT surgeon after relevant investigations was recorded. Analysis of diagnostic accuracy by non-ENT surgeons was carried out.</p> <p><strong>Results</strong><br />Out of 8019 cases seen in the department of ENT and Head &amp; Neck Surgery from 15th March 2022 to 25th November 2022, 400 cases were asked for consultations. Consultations were more frequently asked from Internal medicine and subspeciality followed by Emergency and Pediatrics department. The most common complaint in consultation sheet was throat pain. The commonest ENT and Head &amp; Neck Surgery diagnosis was Allergic Rhinitis, followed by Presbyacusis and Acute Tonsillitis. Two hundred and twenty cases were asked for consultations with diagnosis from the primary department, out of which 183 had correct diagnosis.</p> <p><strong>Conclusions</strong> <br />Different departments do have difficulties in identifying and addressing ENT and Head &amp; Neck Surgery cases and there is benefit from ENT and Head &amp; Neck Surgery consultations. Furthermore, ENT and Head &amp; Neck Surgery consultations do have high educational value for other departments and plays a vital role in patient management.</p> Krishna Chandra Rijal, Krishna Prasad Koirala, Bibek Ghimire, Sangam Adhikari Copyright (c) 2023 Krishna Chandra Rijal, Krishna Prasad Koirala, Bibek Ghimire, Sangam Adhikari Sun, 31 Dec 2023 00:00:00 +0000 Comparison of Culprit Artery Patency Between Diabetic and Non-Diabetic Patients Undergoing Thrombolysis with Streptokinase for ST Elevation Myocardial Infarction <p><strong>Introduction</strong><br />Myocardial Infraction is the leading cause of mortality and mortality globally. Thrombolysis with streptokinase is well established therapeutic intervention in Myocardial Infraction. Timely intervention with adequate myocardial reperfusion is associated with better clinical outcome whereas failed reperfusion due to incomplete or non-reopening of culprit artery is associated with complications. This study aims to compare diabetic and non-diabetic patients with acute myocardial infraction in term is culprit artery patency.</p> <p><strong>Methods</strong><br />This analytical cross-sectional study was carried out in Cardiology Department, Collage of Medical Sciences, Bharatpur from 1st June 2023 to 30th October 2023. Total 80 patients with acute Myocardial Infarction were enrolled in the study. Blood sugar level and twelve leads ECG of each patients were recorded before giving intravenous 1.5 million units of streptokinase over one hour for acute ST elevation myocardial infarction. Coronary angiogram was done after 24 hours of thrombolysis. Patency of the culprit artery was assessed in each patients and compared between diabetics and non-diabetics.</p> <p><strong>Results</strong><br />The study included 57.5 % (n=46) male and 42.5 % (n=34) female patients. Mean random blood sugar level was 160.87 ±40.8 mg/dl. Mean age of the study population was 52.9 ±10.8 years. 40 % (n= 32) of patients were diabetics. The percentage of culprit artery patency was lower in diabetic patients as compared to non-diabetic patients (43.75 % vs 75%).</p> <p><strong>Conclusions</strong> <br />Among both male and female patients the success of thrombolysis in term of culprit artery patency was higher in non-diabetic patients as compared to diabetic patients. </p> Manoj Shrestha, Pramod Bhusal, Manohar Pradhan Copyright (c) 2023 Manoj Shrestha Sun, 31 Dec 2023 00:00:00 +0000 Clinical Psychopathology During Covid-19 Pandemic <p>The coronavirus disease 2019 (COVID-2019) pandemic and its consequences on individuals’ social, economic, and familial lives have&nbsp;negatively affected mental health of the general population especially in a vulnerable individual. In this case reports, we aim to highlight the role of such psychosocial stressors related to COVID pandemic resulting in development of Acute Psychosis. In the first case the stressor is associated with fear of getting infected while in the second case fear of being put into Quarantine. Thus health measures should be employed to address psychosocial stressors, particularly related to the use of isolation/quarantine, infection fear and vulnerability among the general population.</p> Arati Thapa Copyright (c) 2023 Arati Thapa Sun, 31 Dec 2023 00:00:00 +0000 Lieno-Adrenal Shunt a Rescue for Porto-Systemic Decompression in 23-Year-Old Female <p>Extra hepatic portal vein obstruction is one of the commonest cause of portal hypertension and upper gastrointestinal bleed in the third world. Portal vein cavernous transformation is one of the hallmarks of EHPVO. Despite various lesser invasive interventional approaches for management of EHPVO, surgical shunts still play an important role in long term treatment of patients with EHPVO. Here we present a case of 23 years old female who presented to the OPD with complains of dull aching abdominal pain for a year which was insidious on onset and gradually progressive. The pain was non-radiating, localized to the left upper quadrant of the abdomen which aggravated on lying on the left side. She underwent lieno-adrenal shunt for porto-systemic decompression and management of EHPVO. This case aims to highlight the use of leino-adrenal shunt as a feasible alternative to Linton’s shunt.</p> Khagendra Ojha, Prasun Yadav, Binaya Timilsina, Vipul Bhushan Mallik, Sagar Khatiwada, Narayan Prasad Belbase Copyright (c) 2023 Prasun Yadav, Sagar Khatiwada, Khagendra Ojha, Vipul Bhushan Mallik Sun, 31 Dec 2023 00:00:00 +0000