Journal of Nepalgunj Medical College

Basic Science Faculties: A Rising Problem

Anup Sharma — Fri, 01 Sep 2023 00:00:00 +0000

In the entire four and half year’s course of MBBS, basic science, the first two years is a part where the foundation of a future doctor is laid. Like in any other school, college or a university, in MBBS also the teachers play an important role. It is obvious that without them no school, college or a university can run.

Pancreatic Tuberculosis: A Case Report

Richa Shrestha, Anup Sharma, Pooja Baidya, Milan Adhikari — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Pancreatic tuberculosis is a rare condition even in countries with high tuberculosis prevalence. It can mimic pancreatic carcinoma in symptoms and radiological studied. Extrapulmonary tuberculosis is common in organs like liver, bowel, spleen, peritoneum and mesenteric lymphnodes than pancreas which is suggestive to have protective role because of its secretions.

Case presentation: A 71 year female presented with abdominal pain with no history of pulmonary tuberculosis. Radiological studies suggested pancreatic carcinoma. Laparotomy was performed and Whipple’s pancreatoduodenctomy specimen was sent to histopathology department along with regional lymphnodes. On gross examination, a mass was noted in uncinate process. Histopathological examination revealed chronic inflammatory granulomatous reaction with Langhan’s giant cells and areas of caseous necrosis. The Ziehl Neelsen (ZN) stain confirmed the presence of acid-fast bacilli diagnosing pancreatic tuberculosis.

Conclusion: Tuberculosis should be considered as one of the differential diagnosis of pancreatic masses, especially in immunocompromised patients, as the outcome to antituberculosis treatment is very favorable.

A Rare Incidence of Poland’s Syndrome in a Female Child: A Case Report

Aayush Bist, Nirajan Bhandari, Piush Kanodia, Pratima Chaulagain — Fri, 01 Sep 2023 00:00:00 +0000

Poland's syndrome is a rare condition characterized by the underdevelopment or absence of chest muscles on one side of the body and malformation of the hand and arm. This condition affects males more frequently than females and its cause is still unknown. The diagnosis is usually made in childhood, but in some cases, it may not be evident until adolescence or adulthood. Treatment options include surgical reconstruction and prosthetic devices to improve arm and hand function and appearance. While this syndrome can have a significant impact on a person's physical and emotional well-being, early intervention and appropriate management can lead to improved quality of life. In our case it was an accidental finding in a 7 months old female with severe pneumonia for whom conservative management was done. We are interested in reporting this case because of its rare presentation, so cases would not get missed by the treating clinician.

Clinico-Bacteriological Evaluation of Surface and Core Tonsillar Tissue in Chronic Tonsillitis

Kumar Shrestha, Dhundi Raj Paudel, Subhash Chandra Mahaseth, Sandeep Pokhrel — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Chronic tonsillitis is the most common disease for Otolaryngologists. Effective treatment of tonsillitis depends on knowledge of the infecting organisms. Controversy regarding the treatment of tonsillitis based on throat culture report still persists. There is always a dilemma whether the antibiotics prescribed for tonsillitis are sufficient for the different organisms on the surface and core of the tonsils. If surface culture is a determinant of bacteriology of the core, then rational therapy could be aimed at organisms cultured by surface swabs.

Aims: To study the correlation of bacteria isolated from the surface and core of the tonsil in chronic tonsillitis and antibiotic sensitivity of the bacterial isolates.

Methods: This was a prospective study carried out on fifty patients, who underwent tonsillectomy for chronic tonsillitis. The swabs obtained from the surface of the tonsil before tonsillectomy and the core of the tonsil post tonsillectomy were sent for isolation of micro-organisms. Antibiotic sensitivity test was performed by Kirby-Bauer Disk Diffusion method on the bacterial isolates.

Results: Bacterial growth was detected in 74% of the total sample, in cultures from the surface or the core tissue or both. 78% of surface samples versus 70% of tonsillar core samples revealed bacterial growth. No pathogens were isolated in 26% of samples. Staphylococcus Aureus and Group A β hemolytic streptococcus were the most commonly isolated organisms. Antibiotics sensitive against these pathogens include Amoxycillin-Clavulanic acid, Cefpodoxime, Amikacin, Levofloxacin, Doxycycline, and Nitrofurantoin.

Conclusion: Our study shows that surface culture does not reliably predict core pathogens in cases of chronic infection. Staphylococcus Aureus and Group A β hemolytic streptococcus were the most commonly isolated organisms from the surface and core of the tonsil. So the antibiotics effective against these organisms should be chosen.

Evaluation of Treatment of Distal Tibia Fracture with an Intramedullary Interlocking Nail and Single Poller Screw

Prateek Karki, Roshani Ranabhat, Sabin Shrestha — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Distal tibia fracture tends to angulate while using a standard intramedullary interlocking nail. By using a single Poller screw, the medullary cavity's functional diameter is reduced. This leads to angulation correction and three-point fixations, which improve the mechanical stability of the nail-bone construct.

Aims: To assess the functional and radiological results of the intramedullary interlocking nail and poller screw in management of adult distal tibia fracture.

Methods: All patients with distal tibia fractures age more than 18 years, treated with intramedullary interlocking nails and a single poller screw at Nepalgunj Medical College between January 2022 and April 2023 were included in this prospective study. Radiological examination involved measuring sagittal and coronal plane angulation pre and postoperatively, while functional outcome was assessed using the Karlstorm- Olerud score. Ethical clearance was obtained from Institutional Review Committee.

Results: Total 30 patients, 19 male and 11 females with mean age of 32.37 ± 11.02 (range 18 to 62 years) were treated. Mean difference of diameter between isthmus and fracture site was statistically significant. There was significant reduction in coronal and sagittal plane angulation after surgery which was maintained till union. All fractures united at an average of 17.60 ± 2.25 weeks, with 90% having good to excellent results.

Conclusion: Using a poller screw with an intramedullary interlocking nail can greatly alleviate the angulation issue with the distal fragment for distal tibia fracture.

Diagnostic Utility of the Milan System for Reporting Salivary Gland Cytology in a Tertiary Hospital of Western Nepal

Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Salivary gland Fine Needle Aspiration Cytology is a well-established pre-operative diagnostic tool done routinely worldwide. Heterogeneity of salivary gland lesions makes Aspiration cytology diagnosis challenging for most cytopathologists. Milan system for reporting salivary gland cytology is a six tier reporting system developed to minimize inter-observer variability, thus to enhance reproducibility of cyto-diagnosis.

Aims: To study diagnostic utility of Milan System for Reporting Salivary Gland Cytology.

Methods: This is a one-year hospital based study done at Department of Pathology, Nepalgunj Medical College Teaching Hospital. It included 46 cases of salivary gland Cytology. Biopsy was available for 22 of them. Fine Needle Aspiration Cytology cases were reported as per the Milan System and subsequently correlated with gold standard histopathology.

Results: Age of patients ranged from 8-79 years with submandibular and parotid gland being the commonly involved ones. Most cases were in Category II (Non Neoplastic) according to Milan System for Reporting Salivary Gland Cytology (48%) followed by Category IVa (Neoplasm- Benign) accounting for 37%. Pleomorphic Adenoma was the commonest Benign Neoplasm. Malignancy (Category VI) accounted for 11% of FNAC while suspicious for Malignancy (Category V) were 6% case. Diagnostic accuracy of the Milan System was calculated as 88.88%. Cohen Kappa test value 0.81 showed strong agreement between cytology reporting by Milan System and biopsy.

Conclusion: The Milan System for Reporting Salivary Gland Cytology should be applied for standardization of salivary gland cytology reporting as there is a good correlation between it and Histopathology, hence are complementary to each other.

Impact of Exclusive Breastfeeding on Anthropometry, Morbidity and Duration of Hospitalization of Infants Under Six Months of Age

Roma Km., Aayush Bist, Shivam Khetan, Amrit Pokhrel, Eliza Oli, Niraj Acharya — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Breast milk is the best feed for the infants. Breast milk has got several immunological benefits protecting the infants from various infectious diseases and some chronic diseases of adulthood. Exclusively breastfed babies get less infected and have proper growth and development.

Aims: To study the impact of exclusive breastfeeding on morbidity and hospital stay of infants of four weeks to six months of age.

Methods: This was a hospital based cross sectional study done at Pediatric department of Nepalgunj Medical College, Nepalgunj, a tertiary care referral hospital in Nepal, conducted over a period of one year from January 2022 - December 2022. All the infants meeting the inclusion criteria were included for the study.

Results: A total of 278 infants of 4 weeks to 6 months of age meeting inclusion criteria were included. More than sixty four percent infants were exclusively breastfed. The majority of patients belonged to modified kuppuswamy class 3. Significant impact on nutritional outcome was seen with feeding pattern as 1.7 higher times chance of being underweight in breastfeeding along with supplementary feeding with a highly significant p value of 0.002. Exclusively breastfed infants suffering from respiratory diseases, gastroenteritis, fever and due to other various morbidities were hospitalized for less than one week. Morbidity and hospital stay had a statistically significant relationship with feeding pattern. Higher morbidity was observed due to various diseases of infancy like respiratory diseases, gastroenteritis, sepsis, etc. in breastfeeding along with supplementary feeding group as compared to exclusively breastfeeding group.

Conclusion: Statistically significant association was found in terms of morbidity, hospital stay and feeding pattern amongst exclusively breastfed infants and breastfeeding along with supplementary fed infants. Less morbidity and shorter hospital stay was observed in exclusively breastfed infants as compared to breastfeeding along with supplementary feeding infants.

Hydrophilic Versus Hydrophobic Acrylic Intraocular Lens Implantation in Paediatric Cataract Surgery

Bikram Bahadur Thapa, Nanda Kumari Gurung — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: The selection of intraocular lens is still debatable in paediatric eye. Due to low cost and fewer intra-operative complication hydrophilic acrylic intraocular lens are implanted in volume in low income countries. There is lack of comparative study of this type of lens with hydrophobic lens in paediatric population.

Aims: To compare the outcomes of hydrophilic acrylic lens and hydrophobic acrylic lens in paediatric cataract surgery.

Methods: Out of 48 eyes included in the study, the Group A (n =24) eyes were implanted with acrylic hydrophilic intraocular lens, and the Group B (n =24) were implanted with acrylic hydrophobic intraocular lens. The children were evaluated pre, intra and postoperatively for different parameter.

Results: The mean age was 6.6±2.7 years at the time of surgery. The most common type of cataract was zonular (58% in Group A and 50% in Group B). Postoperatively, corneal edema was seen in 7(29%) eyes in group A and in 2(8%) eyes in group B. The mean follow-up was 16.9±2.9 months. At one year, the position of the intraocular lens was in the capsular bag in 20 eyes (88.33%) and 24 eyes (100 %) in the group A and B, respectively. Clear visual axis was present in 22 eyes in Group A and 24 eyes in Group B. Posterior capsule opacification occurred in 12(50%) eyes in Group A and 6(25%) eyes in Group B. Two (8.3%) eyes in group A underwent surgical membranectomy due to visual axis opacification. The mean LogMAR visual acuity was 0.56 and 0.52 in group A and B respectively at one year.

Conclusion: Hydrophilic acrylic intraocular lens are good alternative to hydrophobic intraocular lens in Nepal in the treatment of paediatric cataract.

Assessment of Atherosclerotic Cardiovascular Disease Risk in Hypertensive Patient at Dhulikhel Hospital

Sanjaya Humagain, Surya Raj Pathak, Rajendra Prasad Koju — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Cardiovascular disease is the leading cause of death worldwide and the burden of which is rising in low and middle-income countries. Atherosclerotic cardiovascular disease risk scoring is a part of treatment guideline for hypertension and dyslipidemia management.

Aims: This study is carried out to for the assessment of atherosclerotic cardiovascular disease risk among hypertensive patient.

Methods: Hypertensive patients presenting to outpatient department were assessed for atherosclerotic cardiovascular disease risk and the 10 years risk score calculation was done using American College of Cardiology/ American Heart Association pooled cohort equation.

Results: Out of total 212 patients 103 were male and 109 were female. 70 (33.02%) patients were smoker. The average systolic BP was 152 ± 18 mm Hg. Out of all hypertensive patients 164(77.36%) were receiving treatment and 48(22.64%) were newly diagnosed. Total of 76 (35.8%) patients were diabetic, 14 newly diagnosed. Total cholesterol was in the range of 367 mg /dl to 68mg/dl with mean 190 ±35mg/dl. HDL cholesterol range was 15 mg/dl to 78mg/dl with mean 42 ± 12 mg /dl. 10 years atherosclerotic cardiovascular disease risk was < 5% in 51(24.06%), 5 to < 7.5% in 34(16.04%), 7.5 to < 10% in 68(32.08%), 10 to <15% in 35(16.51%) and >15 % in 24(11.32%).

Conclusion: From this study we can conclude that atherosclerotic cardiovascular disease risk among hypertensive population is considerable and risk score calculation should be a part of patient evaluation so that they can be managed appropriately and the future cardiovascular events can be prevented.

Assessment of Functional Outcome of Distal Radius Fracture Treated with Kirschner’s Wire

Sandip Kandel, Dinesh Kumar Shrestha, Prateek Karki, Sabin Shrestha, Sushil Yogi — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Distal radial fractures are most common fracture which accounts 8-15 % of all bony injuries. There is a wide variety of treatment options and selection mainly depends on age, occupation, type of fracture. Fracture realignment is most important element for good functional outcome. Closed reduction and percutaneous k-wire fixation is most convenient method as it is cost effective.

Aims: To evaluate the functional outcome of distal radial fractures treated with closed reduction and percutaneous pinning.

Methods:This prospective observational study was conducted in Nepalgunj medical college Teaching hospital, Kohalpur from September 2021 to August 2022. Patient aged above 18 and below 70 years who had isolated distal radius fracture with k wire fixation. Functional results were assessed at a follow up of 6 months, by modified Gartland and Werley scoring system.

Results: In this study out of 45 cases there were male preponderance 29 (65%). The mean age of our patient was 36.8 (SD±12.80) years. K-wires were removed between four to six weeks of operation depending upon the union and followed for six months. On final follow up variables assessed according to Modified Gartland and Werley scoring system which shows, 25 patients had excellent (51.11%) and 13 good (33.33%) functional outcome. Overall, 84.44% of the patients achieved an excellent to good functional outcome. Still residual pain and dorsal angulation were complications post-operatively and was in acceptable limits in majority of cases.

Conclusion: Closed reduction and percutaneous pinning for distal radius fractures have shown to achieve good functional outcome. Most of the complications after the procedure were within the acceptable limits. Further studies are required to assess its efficacy in various other fracture types.

Pattern of Antibiotic Sensitivity and Resistance in Various Cases of Sepsis in a Mixed Intensive Care Unit set up in a Tertiary Hospital

Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Sepsis has been shown to be one of the critical reasons for Intensive Care Unit admissions of patients for which early and empirical use of antibiotics have been used. Antibiotics resistance is becoming a matter of serious concern, especially in developing countries like ours. In this study, all the cases those were diagnosed with sepsis and had culture positive results for bacteria have been evaluated.

Aims: To find out the common organisms responsible for sepsis in patients admitted to the Intensive Care Unit and to know the antibiotic sensitivity/resistance patterns.

Methods: The study was done from May 2022 to April 2023 in mixed Intensive Care Units on the clinical isolates from blood, urine, sputum, endotracheal tube aspirate, central venous catheter tips and wound swabs and those were sent to microbiology department for culture and sensitivity. All the organisms were identified morphologically and biochemically and antibiotic susceptibility pattern was determined by standard laboratory procedure.

Results: We took a total of 102 samples in which organisms were isolated. The most frequently isolated bacteria were Klebsiella (24.91%) followed by Staphylococcus aureus (24.5%), both were sensitive to Doxycycline and Tazobactam-piperacillin in most cases. Other organisms isolated were Escherichia coli (15.69%), Streptococcus (9.8%), Pseudomonas (8.82%), Acinetobacter (6.86%), Enterobacter species (3.92%) and Proteus (0.98%). Azithromycin was found to be the most resistant drug followed by Amoxycillin/clavulanic acid and Levofloxacin.

Conclusion: Klebsiella was found to be the most prevalent cause of sepsis in ICU. Most of the frequently isolated pathogens were resistant to Beta lactamase inhibitors, Cephalosporins and Quinolones. Regular surveillance of antibiotic susceptibility pattern is very important for setting a guideline to the clinician in choosing an appropriate therapy for patients with sepsis.

Study of Electrocardiographic Changes and Spirometry Findings in Chronic Obstructive Lung Disease

Tilchan Pandey, Jeevan Khanal, Resham Gautam, Shami Pokhrel — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Chronic Obstructive Pulmonary Disease is one of the top three causes of death worldwide and patients have to do pulmonary function test by spirometry to diagnose and to evaluate the severity. Electrocardiogram abnormalities have been found uniformly increasing with the severity by Global Initiative for Obstructive Lung Disease stages.

Aims: To know the role of Electrocardiogram in the evaluation of severity of Chronic Obstructive Lung Disease.

Methods: This was conducted in the department of Internal Medicine of Lumbini Medical College Teaching hospital from December 2021 to June 2022. The Chronic Obstructive Pulmonary Lung Disease was established with history, examination and spirometry along with Electrocardiogram.

Results: Among 72 patients included 40 (55.56%) were in mild to moderate stage and 32 (44.44%) were in severe stage. The mean Force Expiratory Volume in one Second/Force Vital Capacity of severe stage was 38.59± 6.9 and 66.32±7.37 in mild to moderate stages. The electrocardiographic abnormalities like right atrial enlargement (P –pulmonale), right ventricular hypertrophy, complete right bundle branch block, low voltage in limbs, right axis deviation, sinus tachycardia and supraventricular tachycardia were seen in severe stage with statistical significance (p<0.05). Whereas left axis deviation and premature atrial contraction were found in mild to moderate disease and was statistically not significant.Increased percentage of normal electrocardiogram was found in mild or moderate than severe stage with statistical significance. So it is inversely related with the severity of disease.

Conclusion: The relationship between Electrocardiogram findings and degree of airway obstruction was found to be highly significant. So, Electrocardiogram can be used as a surrogate investigation to evaluate the severity of Chronic Obstructive Pulmonary Disease.

Mental Health Literacy among Secondary School Students Attending Government Schools in Kohalpur Municipality

Merina Shrestha, Priyadarshini Shah Singh, Dilsha Rana, Aakash Jaiswal — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Mental Health Literacy is a broader concept under Health Literacy which enables a person to recognize mental disorders, seeks knowledge on prevention of mental diseases, ability to help others, increases use of available health services and enhances improved self-help strategies for better management of mental illness.

Aims: To determine the sociodemographic factors that influence mental health literacy, assessment of knowledge, erroneous beliefs/stereotypes, help-seeking behaviours and self-help strategies associated with mental health.

Methods: A descriptive cross-sectional survey was conducted among the selected secondary school students, by simple random technique from selected government schools in Kohalpur using the mental health questionnaire, (5-point Likert scale). Statistical analysis was done using SPSS 20 and levels of mental health literacy in various domains was calculated.

Results: Among 420 participants, 53.33% were females and 46.67% males with mean age 15.12 years. The proximity to people with mental health problems was 13.1% and without was 86.9%. The Global Mental Health Literacy mean (3.67 with SD+/- 0.30) was taken as the reference point, the mean score above which is considered high and below it is low. Low levels of Knowledge (mean 3.64, SD+/- 0.43) and erroneous beliefs (mean 3.38, SD+/- 0.39) of mental health literacy were observed. Levels of self-help strategies (mean 3.96, SD+/- 0.703) was highest followed by help-seeking behaviours (mean 3.94, SD+/- 0.61).

Conclusion: There are low levels of knowledge and high stereotypes/ erroneous beliefs in secondary school children studying in government schools. Programs aimed to increase knowledge and awareness on mental health and decrease stereotypes need to be implemented at schools.

Diagnostic Utility of Pleural Fluid Cytology versus Cell Block Technique: A Comparative Study

Subarna Acharya — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Categorization between benign and malignant pleural effusions most often create diagnostic dilemma. Categorization often requires clinical findings and morphological evaluation. Diagnostic possibility is increased if cell blocks are performed in addition to conventional cytology smears. This will help the clinicians in both treating the patient and determining the outcome of the disease process.

Aims: The aim of this study was to compare the smears cytology with cell blocks sections in pleural effusions.

Methods: This hospital-based cross sectional analytical study was carried out in Department of Pathology in Nepalgunj Medical College, Nepalgunj for one year.

Results: The four criteria scored for each technique were amount of background blood, yield of diagnostic cellular material, degree of cellular degeneration as well as cellular trauma and architectural preservation. More amount of diagnostic material present and appropriate retention of architecture was more in cell block sections compared with smears cytology; whereas cellular degeneration as well as cellular trauma and background blood was less appreciated in cell block sections which scored more than the smears cytology.

Conclusion: Cell block method especially in clinically, radiologically and cytologically suspected malignant cases should be routinely processed for cell block method.

Histopathological Study of Colorectal Lesions and Its Correlation with Colonoscopic Findings

Richa Shrestha, Milan Adhikari, Shiv Vansh Bharti, Anil Shrestha — Fri, 01 Sep 2023 00:00:00 +0000

Introduction: Colorectal lesions are diverse and have variety of symptoms which overlap with benign and malignant conditions. Cancerous conditions are common in this region, thus early diagnosis influences the response to management. Colonoscopy and histopathological study of lesions is crucial in diagnosis and management of neoplastic conditions.

Aims: To study the correlation of the colonoscopic and histopathological findings in colorectal lesions and spectrum of colorectal lesions.

Methods: This is a hospital based prospective cross-sectional study conducted over the period of 16 months from January 2021 to June 2022 in department of Pathology, Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur, Nepal. Informed verbal consent from the patient was obtained. Patients who have undergone colonoscopy were included in the study whose corresponding histopathological samples were also received in the form of either large or small biopsies.

Results: Total 95 cases were included in the study which showed male preponderance overall as well as in malignant conditions. Adenocarcinoma was most common histopathological finding followed by nonspecific chronic colitis. Most common clinical complain was bleeding per rectum and most common colonoscopic finding was ulceroproliferative lesion. The correlation between colonoscopy and histopathology done as benign and malignant was statically significant.

Conclusion: The current study revealed a good correlation between colonoscopic and histopathological findings. Morphological study helps in identification of disease for early diagnosis and management, especially in malignancy.