Janaki Medical College Journal of Medical Science

Anxiety and depression in elderly people living in an urban community in Kathmandu

2024-04-28T12:02:56+00:00

Background & Objectives: Ageing is associated with several risk factors such as loss of income, loss of spouse, chronic comorbidities, cognitive impairment, bereavement, living alone, decreased physical functionality, and fear of death. Consequently, mental health issues such as anxiety disorders and depression are very common. This study aimed to find the prevalence of anxiety and depression among elderly people living in a community of urban Kathmandu.

Materials and Methods: Levels of anxiety and depression were assessed by interviewing elderly people living in the community of Gokarneswor-7, Kathmandu by using validated Nepali translations of Beck Anxiety Inventory and Geriatric Depression Scale respectively.

Results: One hundred and eight elderly people (52 males, 48%), of mean age 68 years, all living in family, gave complete responses. Both anxiety and depression had prevalence rates of 52% and 2% for severe forms. Comorbidity was found in 36% of the elderly and another 36% had none of the disorders. Anxiety was more common in females and those with comorbid chronic diseases; other socio-demographic factors such as age, occupation, education level, ethnicity, religion, or type of family had no significant association (p>0.05). Depression showed significant association with none of these factors.

Conclusion: Anxiety and depression are common among elderly people living in community in urban Kathmandu. More than one third have both disorders.

Clinico-demographic characteristic and outcome of adult acute organophosphorus (OP) poisoning in Teaching Hospital of Madhesh Province, Nepal

2024-04-28T12:17:15+00:00

Background & Objectives: Organophosphorus (OP) poisoning is a major health problem worldwide, especially in developing countries. This study aimed to find out the demographic, clinical presentation and outcome of OP poisoning patients.

Materials and Methods: A cross-sectional study of two years duration was conducted on patients presenting to Emergency Department (ER) with clinical features of OP poisoning at Janaki Medical College Teaching Hospital (JMCTH), a tertiary care hospital.

Results: A total of 84 cases of acute poisoning were reported in ER-JMCTH. Patient ages ranged from 15 to 60 years. The highest number of poisoning cases was observed in the 15-25 years age group (44 cases 52.4%) male = 33 (39.3%) and female = 51(60.7%), ratio M: F = (1:1.5). Most cases of poisoning were due to suicidal intention (n = 63, 75%), most common toxic substances used for suicidal purposes of OP were chlorpyriphos (n = 56, 66.7%) and dichlorvos (n = 17, 20.2%). Most of the cases belonged to illiterate (n = 26, 31%) and primary education (n=19, 22.6%). About 79.8% of the patient’s symptoms were cholinergic effect (muscarinic), 9.5% nicotinic and 10.7% central nervous system (CNS) effect. Nearly 93% (n = 78) patients survived and 7% resulted in death.

Conclusion: The majority of OP poisoning patients were of young age and OP poisoning was more common in women compared to men. Suicidal poisonings were more frequent than accidental ones. The research team's a treating physicians noted miosis as the most common symptom, whereas patients most frequently complained of nausea and vomiting.

Incidence of drug resistance bacterial isolates from different Pyoderma cases attending at tertiary care hospital of Central Nepal

2024-04-28T12:29:15+00:00

Background & Objectives: Pyoderma is defined as any purulent skin disease and represents infections in epidermis and dermis including hair follicles. Thus, this study was conducted to find out incidence and bacteriological profile of pyodermas as well as to determine their antibiotic susceptibility test of isolated bacteria.

Materials and Methods: The samples were collected in dermatological OPD and sent the collected samples immediately to bacteriology laboratory for culture and sensitivity tests from December 2018 to May 2019 A.D. Antimicrobial susceptibility testing was done using Kirby–Bauer disc diffusion method and the results were interpreted according to the CLSI guidelines. Quality control of the test was done by standard ATCC strains of S.aureus (ATCC 25923), E.coli (ATCC 25922).

Results: The incidence of pyoderma was 3.24%. Maximum cases were detected in the age group below 13 years of age. Primary pyoderma (61.8%) was more frequent when compared to secondary pyoderma (38.2%). The highest number of organism isolated was S. aureus (24.7%) from different cases of pyoderma followed by E. coli (8.2%), CONS (6.1%) and Klebsiella pneumoniae (5.1%) whereas other organisms were found in less number. Gram positive bacteria mainly S. aureus and other isolates for the cause of pyoderma were mostly resistant to penicillin (100%), ciprofloxacillin (75.0%) and clindamycin (79.2%). Gram negative E. coli (8.2%) was second most bacterial isolates and others GNB isolates were (14/63) where resistance pattern were seen more (75.0%) in each ceftrixone and imipenem.

Conclusion: Incidence of pyoderma was low among the patients visiting to the Dermatology Department. Antibiotic resistance is increasing day by day; therefore, routine culture and sensitivity tests are essential to guide proper treatment procedure.

Adverse Birth Outcomes associated with Antenatal Care among Mothers at Madhesh Province, Nepal: A Cross Sectional Study

2024-04-28T12:43:22+00:00

Background & Objectives: High-quality antenatal care (ANC) plays a vital role in reducing maternal and neonatal mortality rates and enhancing health results, especially in low-income nations. Although various factors play a role in adverse birth outcomes, antenatal care (ANC) emerges as a crucial preventive measure. Therefore, this study was conducted to investigate factors that influence participation in antenatal care services and their association with adverse birth outcomes in Madhesh Province of Nepal.

Materials and Methods: A quantitative cross-sectional study was conducted among mothers who delivered their baby at health care facilities of Madhesh Pradesh from July 2020 to January 2021. A total of 104 participants selected for the study. Structured questionnaire was used and face to face interview was carried out to obtain information from participants. SPSS software was used for the data analysis and multiple logistic regression analysis was performed. A p value of less than 0.05 is considered statistically significant.

Results: Among 104 mother, 11 had an adverse birth outcome. Majority of pregnancy related characteristics and antenatal care during pregnancy were significantly associated with adverse birth outcomes. In terms of socioeconomic status, education (p=0.021) and occupation (p<0.0001) showed the significant association with adverse outcome in bivariate analysis. However, in multivariate analysis socio demographic factors such as mothers’ occupation (p=0.004) and antenatal care practice such as rest during pregnancy (p=0.023) remained statistically significant.

Conclusion: Finding suggests that mothers’ occupation and rest during pregnancy were associated with adverse birth outcomes. Therefore, raising awareness through prenatal care educational programs may reduce the likelihood of adverse delivery outcomes.

Status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal: A descriptive cross-sectional study

2024-04-28T14:45:27+00:00

Background & Objectives: In this modern age, the preferred course of treatment for gallstone disease symptoms is laparoscopic cholecystectomy. For securing both the cystic duct and artery with a single ligation (SLAD), is a quicker and safe procedure. The study was aimed to determine the status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal.

Materials and Methods: A total of 205 patients with gallstone, who underwent laparoscopic cholecystectomy at tertiary center of Nepal of age group 16 - 70 years were included. During the procedure the cystic duct and artery was tied with single ligation. Data were subjected to Microsoft excel 16 for analysis.

Results: Laparoscopic cholecystectomy was performed in 205 patients with gallstone. Average age of patients was 31.54 yrs. There was female predominance in the study. The cystic duct and artery were tied in single ligature using nonabsorbable Silk 2-0. The mean time taken for ligation was 120.78 ± 26.92seconds. Bile leakage and intra-op bleeding were found in two patients without any mortality.

Conclusion: In laparoscopic cholecystectomy, a viable and secure alternate technique for securing the cystic artery and duct is single ligation with the use of non-absorbable thread. Even though it is a common procedure, it has an additional benefit over clips when dealing with thick, edematous cystic artery and duct complexes. It lowers the threat of surgical morbidity and does not increase the intra operative time.

The Prevalence and Risk Factors of Type 2 Diabetes Mellitus among Adults in Itahari Sub-Metropolitan City of Eastern Nepal

2024-04-28T14:58:57+00:00

Background & Objectives: Diabetes Mellitus presents a substantial health challenge worldwide. Its prevalence has been increasing more rapidly in low and middle-income countries such as Nepal. Globally, the number of individuals affected by diabetes rose from 108 million in 1980 to 422 million in 2014. The study was aimed to assess the prevalence of Type 2 Diabetes Mellitus (DM) and explore the associated risk factors with Type 2 DM.

Materials and Methods: A community-based cross-sectional study was designed to investigate the adult population of Itahari sub-metropolitan city in Sunsari district, Nepal. The study included individuals aged ≥ 18 years of both genders residing in Itahari sub-metropolitan city, an urban area of Sunsari District. Data collection was conducted through face-to-face interviews using a semi-structured, pre-tested WHO STEPS survey questionnaire. Collected data were entered into Microsoft Excel and then imported into the Statistical Package for Social Sciences (SPSS) for statistical analysis. Bivariate analysis was performed using the chi-square test and Fisher’s exact test.

Results: Out of 322 participants, 64 (19.9%) individuals were diagnosed with Type 2 Diabetes Mellitus, either with or without hypertension. Among the diabetic participants, 39 (60%) had comorbid hypertension, while the remaining 25 (39.06%) did not exhibit hypertension.

Conclusion: Anxiety and depression are common among elderly people living in community in urban Kathmandu. More than one third have both disorders.

Complaints and Advices of Alternative Medicine among Pilgrimages Visitors in Vivahpanchami at Janakpurdham, Nepal

2024-04-28T15:09:06+00:00

Background & Objectives: Potential health related risks and spread of communicable disease is one of the challenges of religious mass gatherings. With the rise of globalization, parts of Ayurveda are now popularized as a form of alternative medicine. In Nepal, Ayurveda medicine faces lots of challenges, and is under threat due to inadequate funding, ignorance of modern diagnostic technologies, and insufficient quality research. It is vitally important to continually monitor and promote Ayurveda in the modern era of allopathic medicine. Thus, this study aimed to identify the main complaints and advices on Ayurvedic medicine among pilgrims visiting Vivahpanchmi in Janakpurdham, Madhesh Province, Nepal.

Materials and Methods: The information was gathered from the registration book of pilgrims who attended an Ayurveda health camp at Rangbhumi Maidan (Barahbigha) in December 2023, organized by the Ayurveda and Alternative Medicine center, Janakpurdham Sub Metropolitan office, Dhanusha, Madhesh Province. The extracted data were imported into MS Excel and SPSS 20 was used for analysis. Data were expressed in frequencies and percentage.

Results: Of the 707 pilgrims, 97.7% were from India and 2.3% were from Nepal; 68.9% of the visitors were women and 31.1% were men. Out of all visitors, less than 10% were over 60, and more than half were between the ages of 41 and 60. Gastritis accounted for the highest percentage (45.9%), followed by joint pain, weakness, back pain (31.3%), and coughing (17.1%). Only 4.4% of people reported being constipated.

Conclusion: The most common complaints from Pilgrims were related to gastritis (Amlapitta), which was followed by joint discomfort, weakness, and back pain (Vata). The possible ayurvedic advices and medications were provided and distributed among the pilgrims during Vivahpanchmi.

Cytological Findings of Fine Needle Aspiration Cytology in Diagnosing Causes of Cervical Lymphadenopathy in Patients Attending Health Care Facilities of Janakpur, Nepal

2024-04-28T15:21:17+00:00

Background & Objectives: Fine Needle Aspiration Cytology (FNAC) is a minimally invasive and inexpensive procedure that produces a rapid result. As cervical lymphadenopathies are common clinical findings with varied causes, FNAC may have an extremely important role in the diagnosis of various underlying clinical condition.

Materials and Methods: A prospective multicentric study was conducted from September 2021 to June 2023 at Janakpur, Nepal. A total of 60 cases were included in the study. The procedure was performed in the cervical lymph node with a 10 ml syringe and 23 gauze needle. The obtained material was spread on the slides and stained with leishman stain and Papanicoloau (PAP) stain. Acid Fast Bacilli (AFB) stain was done for suspected cases of M. tuberculosis infection.

Results: The diagnosis based on FNAC procedure were categorized as reactive lymphadenitis (21 cases, 35%), tuberculous lymphadenitis (14 cases, 23.33%), granulomatous lymphadenitis (8 cases, 13.33%), suppurative lymphadentitis (7 cases, 11.66%) and positive for malignancy (3 cases, 5%). The most common diagnosis in the current study of cervical lymphadenopathy was reactive lymphadenitis followed by tuberculous lymphadenitis.

Conclusion: FNAC is a quick and reliable method to find the cause of cervical lymphadenopathy allowing appropriate diagnosis, timely management and further investigation if needed.

Ebola Haemorrhagic Fever: An Overview

2024-04-28T15:32:41+00:00

Ebola virus disease is a rare but severe, often fatal illness in humans. Fruit bats are the natural reservoirs of Ebola virus, and it is transmitted to humans from wild animals and spreads between humans. Ebola virus is a class A bioterrorism agent, known to cause highly lethal haemorrhagic fever. Clinical symptoms include fever, myalgia, headache followed by vomiting, diarrhea, hemorrhagic rash, bleeding, and multi-organ failure. Vaccines to protect against Ebola have been developed and used to control the spread of Ebola virus disease. Treatment is mainly early supportive care with rehydration and symptomatic treatment. Ebola virus is a neglected pathogen and the knowledge and scientific information on Ebola virus disease is relatively limited and received little attention. Better understanding of ebolavirus disease mechanisms is needed to guide development of drugs, vaccines, and treatment strategies. Hence this comprehensive review on Ebola virus is undertaken to provide an overview of its transmission, pathogenesis, clinical symptoms, differential diagnosis, laboratory diagnosis, treatment, vaccines and preventive aspects and to highlight its importance, and impact on public health and further research.

Facilitating problem-based learning sessions

2024-04-28T11:43:04+00:00

No abstract available.

Osteoplastic Reconstruction of the Thumb: a case report

2024-04-28T15:40:32+00:00

Background & Objectives: Thumb accounts for 50% of the hand function. Amputation of the thumb severely jeopardises the hand function. Thumb replantation, toe transfer are the ideal methods for restoring the hand function, but is not always possible owing to type of injury, time to presentation, surgical skill and set up. Osteoplastic thumb reconstruction for amputation around the metacarpophalangeal joint is a good treatment option to restore the hand in a developing setup.

Presentation of Case: A 25 yrs male with amputation of thumb around metacarpophalangeal joint with delayed presentation and crushing component of distal part underwent multiple staged osteoplastic reconstruction of the thumb. The procedures consisted of bony structure fixation with bone graft followed by coverage with a thinned tubed groin flap which was divided at 2 weeks interval. The thumb was made sensate with sensate flap (first dorsal metacarpal artery flap).

Discussion: Thumb replantation is ideal in acute setup in a clean traumatic amputation, while toe transfer is ideal in a delayed setup with healed wound. This requires a good operating room set up with microsurgical set up and skilled manpower, which is difficult in a developing country. Osteoplastic reconstruction requires multiple staged procedures that can be done at a primary level setup.

Conclusion: Osteoplastic thumb recontruction is a good option for amputation around the metacarpophalangeal joint to restore hand function in a resource limited set up.