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) Thu, 30 Jun 2022 00:00:00 +0000 OJS 60 Association of Adverse Effects following COVID-19 Immunization with Previously COVID-19 Infected and Non- Infected Health Care Professionals <p><strong>Introduction: </strong>The immunogenicity of COVID-19 disease and variability among adverse effects following COVID-19 vaccine in previously infected and non-infected individuals is not clearly understood. So, this study aims to assess the association of adverse effects of COVID-19 vaccine with previously infected and non-infected individuals.</p> <p><strong>Methods: </strong>A case-control study was conducted at College of Medical Sciences, Bharatpur, Chitwan, Nepal from July 2021 to February 2022 among 324 health care professionals who had received two doses of COVID-19 vaccine. Cases included those who developed any adverse effects following COVID-19 immunization and controls included those who did not develop any adverse effects. Exposure was presence and non-exposure was absence of previous COVID-19 infection. The data collected was analyzed in SPSS version 17 software in terms of frequency, percentage, mean, standard deviation, chi-square, exposure rates and odds ratio.</p> <p><strong>Results: </strong>Mild adverse effects like fever, myalgia, headache and pain in injection site were observed following both first dose (46.9%) and second dose (6.17%) of vaccine. The exposure rate was more in cases (23.45%) than in controls (11.11%). Odds ratio was 2.452 (95 % CI, 1.332 to 4.512, p&lt;0.05) which is statistically significant.</p> <p><strong>Conclusions:</strong> The risk of developing adverse effects following COVID-19 immunization was 2.452 times more in health care professionals who were previously infected with COVID-19 as compared to those who were not infected. Thus, there is a significant association of adverse effects following COVID-19 immunization with previous COVID-19 infection.</p> <p><strong>Keywords: </strong>adverse effects; following immunization; association; case-control study; COVID-19 vaccines; health care professionals</p> Prerna Bansal, Pallavi Koirala, Ayasha Shrestha, Hari Prasad Upadhyay, Kamal Khadka, Ranjeeta Phuyal Copyright (c) 2022 Dr. Prerna Bansal, Dr. Pallavi Koirala, Dr. Ayasha Shrestha, Mr. Hari Prasad Upadhyay, Dr. Kamal Khadka, Dr. Ranjeeta Phuyal Thu, 30 Jun 2022 00:00:00 +0000 Literacy of Suicide among Doctors and Nurses at a Tertiary Care Hospital in Nepal <p><strong>Introduction: </strong>Increased knowledge and improved attitudes about suicide are important factors for suicide-prevention strategies. Not only mental health professionals and public, but doctors and nurses working in other departments and general hospitals, especially in resource limited low-middle income country like Nepal, need to be knowledgeable identifying and making appropriate referrals for mental health issues and suicidal patients. This study was conducted to assess doctors and nurses’ literacy of suicide at a tertiary care government center in Nepal.</p> <p><strong>Methods: </strong>A descriptive cross-sectional questionnaire-based study was conducted among doctors and nurses working at the hospital. Literacy of suicide scale was utilized to assess the status of literacy regarding suicide among 188 study participants. Descriptive statistics were applied.</p> <p><strong>Results: </strong>The total mean literacy of suicide scale (LOSS) score was calculated to be 13.07 (SD=3.65). Higher number of participants, 117 (62.2%) scored above mean on total LOSS score. Performance was the poorest on recognizing the signs of suicide while it was best on identifying the cause of suicide. People with relationship problems or financial problems have a higher risk of suicide was correctly identified by 89.9% of the participants. While only 60 (31.9%) participants correctly answered item “men are more likely to suicide than women” from the domain risk.</p> <p><strong>Conclusions: </strong>Majority of nurses and doctors performed better on the literacy of suicide scale. Health professionals were found knowledgeable about suicide. Those with higher level of education, specialization and training in mental health scored higher. Future studies among various categories of population and association of level of literacy and attitude, practices is needed.</p> <p> </p> Sunil Shah, Dipendra Neupane, Kamlesh Kumar Sah Copyright (c) 2022 sunil shah, Dipendra Neupane, Kamlesh Kumar Sah Thu, 30 Jun 2022 00:00:00 +0000 Microbiological and Antibiotic Profile of Broncho-Alveolar Lavage Aspirate in Mechanically Ventilated Patients in a Tertiary Care Hospital <p><strong>Introduction:</strong> VAP increases the patient stay in the ICU and indirectly increases the cost of patient management. Based on the time of onset of VAP, it can be divided into two types. Early-onset VAP occurs during the first four days of mechanical ventilation and is usually caused by antibiotic sensitive bacteria. Late-onset VAP develops five or more days after initiation of MV and is caused by multidrug-resistant (MDR) pathogens.<sup>5</sup> Early diagnosis of VAP with appropriate antibiotic therapy can reduce the emergence of resistant organisms.</p> <p><strong>Methods: </strong>This cross-sectional study was done in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan after taking clearance from the institutional review committee. Study included all the patients who required mechanical ventilation for more than 72 hoursAll the included patients had their endotracheal tube aspirated using an ambu bronchoscope and sent to microbiology department for culture and sensitivity. The reports were collected after 72.</p> <p><strong>Results: </strong>The most common organism grown during culture and gram staining were Acinetobacter Baumannii (81), followed by Klebsiella Peumoniae (44) than Pseudomonas Aeroginosa (32).. We observed a higher rate of culture positivity from the samples of male patients than those obtained from the female patients. Similar findings were observed by Morehead et al<sup>13</sup>and debjita debnath et al<sup>12 . </sup>In our study, gram-negative bacilli were the most commonly isolated pathogen from BAL which is similar to studies done by, debjita debnath, Fagon et al14 and Şimşek et al15. In our study, Acinetobacter Baumannii (81) was the most common followed by Klebsiella Peumoniae (44) than Pseudomonas Aeroginosa (32),first line of antibiotics in patients who were mechanically ventilated were piperacillin plus tazobactam, meropenem,cotrimoxazole, amikacin and gentamicin. The second line drugs were polymyxin B, colistimethate and tigecycline.</p> <p><strong>Conclusions: </strong>Acinetobactor Baumanni is the most common causative organism of ventilator associated pneumonia. In most of the cases first line antibiotics ( meropenem, amikacin and clotrimoxazole) are sensitive. Among the second line antibiotics, Polymyxin B was found to be most effective.</p> Rajesh Yadav, Ajay Singh Thapa, Rajan Basnet Copyright (c) 2022 Rajesh Yadav Thu, 30 Jun 2022 00:00:00 +0000 COVID-19 Pandemic and its Effect on Mental Health among General Population of Gandaki Province <p><strong>Introduction: </strong>Mental health problem is the big issues during Covid 19 pandemic so this study aims to explore the impact of COVID-19 pandemic on the mental health among general population of Gandaki province</p> <p><strong>Methods:</strong> An Analytical cross sectional study was conducted from Nov/Dec 2021among 168 general population above 18 years of age.Nepali version of self reporting DASS 21 scale was used for data collection. Data was analyzed using SPSS 19.0 version. Descriptive statistics and inferential statistics chisquare &amp; bivariate logistic regression was used for data analysis</p> <p> <strong>Results:</strong> Among the participants 29.8% had depression, 26.8% had anxiety and 16.1% had stress in varying severity from mild to extremely severe forms. There was signification association between depression and religion, marital status and educational status and there was association between anxiety and stress with marital status and occupation but there is no significant with other demographic variables. Bivariant regression models revealed unmarried respondents were 2.6 times more likely to have depressive symptoms, below Graduation educational status were 3 times more likely to have depressive symptoms. Unmarried respondents were 2.4 times more likely to have anxiety, in the same way unmarried respondents were 5 times more likely to have stress at 95 % CI i.e. pvalve &lt;0.05.</p> <p><strong>Conclusions:</strong> More than one fourth respondents was having depressive symptoms, anxious and near to one fifth was stressed so there should be increasing public awareness of mental health and coping strategies is essential to promote mental health to the general population of Gandaki province.</p> <p><strong>Keywords</strong>: COVID-19; pandemic; mental health; general population.</p> Sandhya Shrestha, Bandi Gurung, Bipula Gaire, Tsewang Palmo Gurung, Nikita Shahi Copyright (c) 2022 Sandhya Shrestha Thu, 30 Jun 2022 00:00:00 +0000 Evaluation of POSSUM Score for Outcome Prediction in Patients undergoing Major Gastrointestinal Surgery in Population of Central Nepal <p><strong>Introduction: </strong>The POSSUM score is one of the several risk scores to predict postoperative morbidity and mortality in the surgical domain.This study was designed to assess the validity of POSSUM scoring system in patients undergoing gastrointestinal surgeries in our setup and to analyse the outcome and compare the observed and expected values.</p> <p><strong>Methods:</strong> An analytical cross sectional study was conducted among 100 patients in the Department of Surgical Gastroenterology after taking ethical approval from COMS-IRC. Data was analysed using SPSS -20 via descriptive and inferential statistical tools. p-value &lt;0.05 was considered statistical significant.</p> <p><strong>Results: </strong>Using POSSUM score the expected morbidity was 54% and mortality was 21.47%.The observed morbidity was 54% and mortality was 13%. The observed to expected (O: E) morbidity was 1.03 and mortality was 0.61 and there was no statistically significant difference between observed and expected value. The area under curve for POSSUM mortality score was 0.896 and the sensitivity and specificity of POSSUM score to predict mortality was 93.2 and 83.9 respectively.</p> <p><strong>Conclusions: </strong>POSSUM score is a good mathematical tool in predicting morbidity and mortality in patients undergoing gastrointestinal surgeries.</p> <p><strong>Keywords:</strong> gastrointestinal surgeries; central Nepal; expected morbidity and mortality; observed morbidity and mortality; POSSUM score.</p> Narayan Prasad Belbase, Dr.Sagar Khatiwad, Dr.Nishnata Koirala, Hari Prasad Upadhyay, Dr.sushim Bhujel, Dr.Bikash Shah Copyright (c) 2022 Narayan Prasad Belbase, Dr.Sagar Khatiwad, Dr.Nishnata Koirala, Hari Prasad Upadhyay, Dr.sushim Bhujel, Dr.Bikash Shah Thu, 30 Jun 2022 00:00:00 +0000 Comparative Cytomorphometric Study of Exfoliated Oral Epithelial Cells from a Population of Smokers, Tobacco Users and Gutkha Chewers <p><strong>Introduction: </strong>Tobacco remains one of the most important preventable cause of addiction, sickness and mortality in the world as it affects the oral epithelium. Normal epithelium undergoes continuous exfoliation or shedding of its superficial cells, and it is replenished by new crop of cells from the basal layer. The rationale of exfoliative cytology lies in the epithelial physiology. The purpose of this study is to conduct quantitative cytomorphometric studies on squames obtained from a population of Tobacco and Gutkha users, to assess the cytomorphometric changes in Nuclear Area (NA) and Cytoplasmic Area (CA) of squames from tobacco smokers, tobacco chewers, gutkha chewers, to compare the results with control group normal healthy individuals and among themselves.</p> <p><strong>Methods:</strong> Oral smears were taken from buccal mucosa of total 200 individuals. The smears were histochemically stained and cytomorphological assessment was done. Groups were compared by one way analysis of variance (ANOVA) and the significance of mean difference between the groups was done by Tukey’s post hoc test after ascertaining normality by Shapiro-Wilk test and<br />homogeneity of variances by Levene’s test.</p> <p><strong>Results: </strong>The mean Nuclear area of tobacco chewer (C) was the highest and the normal individual (N) was the least. The mean Cytoplasmic area of normal individual (N) was the highest and the tobacco chewer(C) was the least.</p> <p><strong>Conclusions: </strong>This study supports and extends the view that cytomorphometric evaluation of keratinocytes can serve as a useful diagnostic adjunct for early detection of oral cancer. </p> <p><br />Keywords: exfoliative cytology; cytomorphometric; tobacco users; gutkha users.</p> Nishant, Bhagwat Swaroop Sharma Copyright (c) 2022 Nishant, Dr. Bhagwat S.Sharma Thu, 30 Jun 2022 00:00:00 +0000 Women’s Choice of Immediate Postpartum Reversible Contraceptives Visiting a Tertiary Hospital of Nepal <p><strong>Introduction: </strong>Long-acting reversible contraceptives (LARC, Intrauterine contraceptives devices and Implants) stand on 1st regards to safety and effectiveness. It is an easily accessible variety for spacing birth as well as preventing unintended pregnancy soon after childbirth in Nepal due to free supply by the Government under safe motherhood program of Reproductive health policy. Despite free supply, LARC is not routinely implemented in practice among immediate post-partum lady as single approach contraceptives concern to unintended pregnancy due to unmet need. To find out the choice of LARC by antenatal and immediate postpartum women after delivery.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was conducted among 200 women in antenatal clinic and obstetric ward of College of Medical Science and Teaching Hospital using non probability convince sampling technique. Ethical approval was taken form Institutional Review Committee of College of Medical Sciences and Teaching Hospital and data was analyzed using descriptive statistical tools in SPSS.</p> <p><strong>Results:</strong> Twenty eight percent of antenatal and 42% of postnatal women had induced abortion for unintended pregnancy in past. All women had knowledge about modern method of contraception but only 47 percent antenatal and 58 percent postnatal women adopted contraception in past. Implant was chosen by 44% antenatal and 46% postnatal women; whereas IUCD was chosen by 45% antenatal and postnatal women as LARC. Jadelle was the choice of LARC in both group due to its convenient duration (5 years) for birth spacing and its safety profile during breastfeeding. Twenty women refuse for LARC in immediate postpartum period.</p> <p><strong>Conclusions:</strong> Single approach immediate postpartum LARC in is chosen by women who had induced abortion for unintended pregnancy in past for its long action, convenience during breast feeding and reliability. Maximum antenatal women prefer IUCD compared to Implants among postnatal women.</p> <p><strong>Keywords:</strong> Copper T; Immediate post-partum; Jadelle; long-acting reversible contraceptives; Puerperium; Unintended pregnancy.</p> Subha Shrestha, Buddhi Kumar Shrestha, Rubina Shrestha, Hari Prasad Upadhyay, Sneha Poudel Copyright (c) 2022 Dr. Subha Shrestha, Dr. Buddhi kumar shrestha, Dr. Rubina shrestha, Mr. Hari Prasad Upadhyay; Dr. Sneha Poudel Thu, 30 Jun 2022 00:00:00 +0000 Albuminuria in Patients with Type 2 Diabetes Mellitus: a Single Center Cross-Sectional Study <p><strong>Introduction:</strong> Diabetes mellitus is one of the commonest non-communicable diseases in Nepal and is associated with long term microvascular and macro vascular complications. Detection of albumin in urine is the earliest recognizable feature in the development of proteinuric diabetic nephropathy. This study aims to study the prevalence as well the determinants of albuminuria in patient with Type 2 diabetes mellitus visiting the medical OPD of College of Medical Sciences-Teaching hospital.</p> <p><strong>Methods:</strong> This was a cross-sectional study done from January to June 2022 among Type 2 diabetes patients presenting to medical OPD for the comprehensive diabetes management. Relevant epidemiological, clinical and laboratory data were obtained. Urine dipstick test was done to screen for albuminuria. The prevalence and determinants of albuminuria were studied.</p> <p><strong>Results:</strong> Study among 360 patients with mean age of 58.5 <u>+</u> 10.9 years and the mean duration since the diagnosis of diabetes of 6.8 <u>+</u> 5.5 years, showed that the prevalence of albuminuria was 33.3%. Albuminuria in these patients was found to have significant association with age (P&lt;0.001), duration since diagnosis of diabetes (&lt;0.001) and HbA1c (P&lt;0.001). No significant association of albuminuria was found with gender (P=0.087), hypertension (P=0.063) and previous use of Angiotensin-converting enzyme inhibitors/ Angiotensin II receptor blockers. (P=0.217)</p> <p><strong>Conclusions:</strong> Albuminuria is highly prevalent among our cohort of diabetic patients. Increasing age, longer duration since diagnosis of diabetes and higher HbA1c are the factors significantly associated with it.</p> Pukar Ghimire, Hari Prasad Upadhyay Copyright (c) 2022 Dr., Hari Prasad Upadhyay Thu, 30 Jun 2022 00:00:00 +0000 Variations in Origin and Branching Pattern of Anterior Division of Internal Iliac Artery: a Cadaveric Study <p><strong>Introduction: </strong>Detailed knowledge of the branching pattern of internal iliac artery will be a guidance for ligating the artery and its branches during various pelvic surgeries. Hence, the main objective of this study was to know the branching pattern of internal iliac artery, based on the Adachis Classification along with the length and diameter of the arteries. </p> <p><strong>Methods: </strong>The descriptive observational cross-sectional study was conducted at the Department of Human Anatomy of the Nepal medical college, examined over a period of 9 months from June 2021- February 2022 which included 30 internal iliac arteries and its branches of right and left sides from 15 embalmed male human cadavers.</p> <p><strong>Results: </strong>In the study, branching pattern of internal iliac artery (IIA) was Type Ia in 19 (63.33%) and Type III in 11 (36.66%) of the cases while type I b, Type II a, Type II b, IV and V pattern were not observed. The total minimum and maximum lengths of both right and left trunk of internal iliac arteries were 1.33 cm and 3.42 cm respectively and average lengths with standard deviation were 2.61cm ± 0.66.The calculated P valve (0.002) showed that the differences between the lengths of IIA of both sides were statistically significant. The diameter and standard deviation of IIA and obturator artery were 6.37±1.33 and 2.47cm±0.67 respectively. The obturator artery was found to be originated from both anterior and posterior division of IIA accounting as 96.66% and 3.33% respectively.</p> <p><strong>Conclusions: </strong>Pelvic surgeries may lead to hemorrhage if branching patterns of the IIA are incorrectly interpreted and thus endanger the patient’s life while ligating the artery during prostatectomy, hernioplasty. The current study explain the important aspects of the vascular anatomy of the IIA not only for anatomists and morphologists, but also for the radiologists, general and vascular surgeons.</p> <p><strong> </strong><strong>Key words: </strong>internal iliac artery; inferior gluteal artery; internal pudendal artery; obturator artery; variations.</p> Allin Pradhan, Manish Man Pradhan, Rabita Kharbuja, Deepika Karki, Shaligram Dhungel Copyright (c) 2022 Allin Pradhan, Dr., Mrs., Dr., Dr. Thu, 30 Jun 2022 00:00:00 +0000 Comparative Study of Single versus Double Burr Hole Drainage for Chronic Subdural Hematoma <p><strong>Introduction: </strong>Various surgical technique is used for evacuation of chronic subdural hematoma. Burr hole drainage is a most preferred. However, there exist a controversy regarding single versus double burr hole among neurosurgeon. This study aims to compare the single versus double burr hole drainage for chronic subdural hematoma in terms of mortality, wound infection and<br />recurrence.</p> <p><strong>Methods: </strong>A retrospective observational study was performed over the period of 3 years. Data were collected in terms age, gender, type of surgery, mortality, wound infection and recurrence. These data were analysed to compare between the single versus double burr hole groups. </p> <p><strong>Results: </strong>A total of 53 patients with chronic subdural hematoma underwent burr hole drainage were enrolled. Mean age of patients was 61.87 ± 17.35 years with male to female ratio 4.88:1. In this study, single burr hole was performed in 35 patients (66%) versus double burr hole in 18 patients (34%). Superficial surgical site infection was observed in 3 patients (5.7%) wherein 1 from single burr hole and 2 from double burr hole group with no statistically significant association (P value = 0.26). There was only 1 recurrence (1.9%). This was from single burr hole group versus no recurrence from double burr hole group which was not statistically significant (P value = 1.00). There was no mortality in both the groups in this study.</p> <p><strong>Conclusions: </strong>There is no effect on mortality, infection and recurrence comparing single versus double burr hole drainage following evacuation of chronic subdural hematoma.</p> <p><strong>Keywords:</strong> burr hole drainage; chronic subdural hematoma; recurrence.<br /><br /></p> Bidur KC, Bikram Shakya, Amit Thapa Copyright (c) 2022 Bidur KC, Bikram Shakya, Amit Thapa Thu, 30 Jun 2022 00:00:00 +0000 What More to do to Make Online Teaching an Attractive and Effective Tool for Medical Students? An Experience from a Rural Tertiary Care Institute in Haryana State, India <p><strong>Introduction:</strong> Though online teaching-learning methodology is not a new way of transferring knowledge and skill, however pandemic of COVID-19 has made it more relevant to all fields. Medical education is majorly dependent on patients and related resources. However, the current pandemic has pushed the medical fraternity to use online methods. Understanding the perception of end-users (medical students) may help get the best out of this methodology. Hence, we planned this study to know medical students' perception of the online teaching-learning methodology.</p> <p><strong>Methods:</strong> The present cross-sectional study was executed among the undergraduate medical students, from the first year to final year, of Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan, Sonepat of Haryana state, India. The data were collected through a semi-structured questionnaire sent to all students as a link to Google form. The study sample was selected through stratified random sampling. We assumed every batch of students as a stratum and randomly selected 25 students from each batch; hence, data analysis from 100 students was conducted.</p> <p><strong>Results:</strong> Most participants found the online teaching-learning methodology comfortable, time and money-saving. However, almost all of them refuted online methods for clinical or bedside teaching. Family distractions, internet connectivity, physical discomfort, isolated feeling, and poor interaction among peers were reported as barriers to online methods.</p> <p><strong>Conclusions:</strong>Selective use of online teaching-learning methodology with inbuilt peer interaction has enormous potential in medical education.</p> Ramesh Kumar Verma, Vijay Kumar Verma Copyright (c) 2022 Ramesh Verma, VIJAY KUMAR Thu, 30 Jun 2022 00:00:00 +0000 Asymptomatic Massive Fibrous Dysplasia Obliterating Maxillary Sinus Extending to the Skull Base: a Case Report and Review of Literature <p>Fibrous dysplasia is a rare bone condition in which normal bone is replaced by aberrant fibrous tissue. The patient may come to evaluate with other diseases and while doing investigations, it is observed. Here we present a case of 24 years male with fibrous dysplasia who came to our OPD with swelling around the left cheek region for 5 days. The patient underwent a Computerised tomography scan which revealed an expansile, sclerotic, cystic ground-glass appearance that extended to the maxillo-alveolar ridge, right sphenoid sinus wall, right pterygoid plate, and zygomaticofacial suture. The right maxillary sinus was almost obliterated.&nbsp; These radiographical features of the lesion were indicative of fibrous dysplasia in the maxilla.</p> Brihaspati Sigdel, Bhima Neupane, Amrit Pokhrel, Bikash Kshetri, Keshab Sharma, Ashish Ghimire, Avinash Jha Copyright (c) 2022 Brihaspati Sigdel, Bhima Neupane, Amrit Pokhrel, Bikash Kshetri, Keshab Sharma, Ashish Ghimire, Avinash Jha Thu, 30 Jun 2022 00:00:00 +0000 Common Illness with an Uncommon Course- In Adolescents use HEADSS <p>Adolescence is a period of emotional instability, during which high risk behavior including experimentation with drugs is common. Clinical manifestations of substance abuse and its withdrawal may mimic common illnesses. We report an adolescent who presented with acute dysentery with unusual course. HEADSS screening revealed psychosocial stressors leading to cannabis addiction. The child was diagnosed to have cannabis withdrawal. He was referred to the de-addiction clinic. HEADSS is a useful tool to identify risk factors and protective factors in adolescents. HEADSS screening during each interaction and early intervention when needed must be an essential component of adolescent health care.</p> Thasma Santhanakrishnan Arunprasath, Padmasani Venkat Ramanan, K Arun Karthik Copyright (c) 2022 Padmasani Venkat Ramanan, K Arun Karthik, Thasma Santhanakrishnan Arunprasath Thu, 30 Jun 2022 00:00:00 +0000