Journal of Patan Academy of Health Sciences <p>Published by the Patan Academy of Health Sciences, Kathmandu, Nepal</p> Patan Academy of Health Sciences en-US Journal of Patan Academy of Health Sciences 2091-2749 <p>© Journal of Patan Academy of Health Sciences</p><p>Submission of the manuscript means that the authors agree to assign exclusive copyright to JPAHS. All authors must sign a Copyright Transfer and Author Agreement form upon submission of the manuscript to the Journal. The work shall not be published elsewhere in any language without the written consent of JPAHS. The articles published in this journal are protected by copyright which covers translation rights and the exclusive rights to reproduce and distribute all of the articles printed in the journal.</p> Large emphysematous bulla after COVID 19 pneumonia <p>A 38-year-old man, with history of COVID 19 pneumonia 23 days back, non-smoker and known case of hypertension presented to the emergency department with complain of sudden onset multiple episodes of blood mixed sputum associated with shortness of breath and sharp type of left sided chest pain for last five hours. The patient was dyspneic, tachypneic and hypoxemic at the time of examination with SPO2 of 84 to 86% without oxygen which improved to 95-96% after 15 liter/min of oxygen via high flow nasal cannula. There were no breath sounds in left hemi thorax and decreased breath sound on right side with basal crepitation. Chest radiograph revealed left sided pneumothorax, needle decompression done immediately followed by chest tube insertion and maintaining 95-96% oxygen at 8 l/m after the procedure. The patient was admitted, and HRCT revealed giant emphysematous bulla in posteromedial aspects of left lobe. This is to highlight the complications that were observed in post COVID patient.</p> Dipesh Mangal Joshi Rony Maharjan Jyoti Shah Copyright (c) 2022 2022-06-17 2022-06-17 9 1 12 17 10.3126/jpahs.v9i1.44265 Live online lecture versus classroom lecture: perception of undergraduate medical and nursing students and faculty <p><strong>Introduction</strong>: During COVID-19 pandemic, live online lectures were offered for the first time to the undergraduate students. Due to its novelty, it was important to identify the effectiveness. Thus, the aim of this study was to compare the perception of students and faculty regarding the attributes of lectures delivered via live online versus classroom platform.</p> <p><strong>Method: </strong>In this descriptive study, after approval from the ethical committee, link to the validated questionnaire was sent via email to all participants. Quantitative data were expressed as numbers and percentage while thematic analysis was done for qualitative data.</p> <p><strong>Result: </strong>In this study 22 faculty members and 176 students participated. Twenty-one (95%) faculty and 159 (90.3%) students agreed that it was a good initiative to start live online lectures during the pandemic, and 18 (81.8%) faculty and 160 (91%) students were satisfied or partially satisfied with online mode. Limitations identified were technical issues and lack of physical interaction. Both faculty members 18 (81.8%) and students 116 (65.9%) agreed or strongly agreed that online lectures were less interactive, and suggested ways to improve online lectures by making sessions more interactive, proper lecture scheduling and using different online media.</p> <p><strong>Conclusion: </strong>Participants identified various strengths of live online mode which is encouraging to use during adverse situations or even continue as a standard platform but it is not without limitations. Thus, for successful implementation, proper planning and designing of lectures are required.</p> Ritu Bashyal Ranjan Devbhandari Prasil Pradhan Jayandra Byanju Sushant Aryal Babu Raja Maharjan Copyright (c) 2022 2022-06-17 2022-06-17 9 1 92 108 10.3126/jpahs.v9i1.42002 Embedding social accountability in the medical school and its curricula: Patan Academy of Health Sciences, Nepal <p><strong>Introduction: </strong>Patan Academy of Health Sciences (PAHS) was established in 2008 with a social accountability mandate and the mission to produce competent and committed health professionals to serve the rural and underserved population. Enrolment of undergraduate medical students started from 2010.&nbsp; This article describes the context and process for the establishment of the Academy, the approaches taken and some of the early outputs.</p> <p><strong>Method: </strong>The information was collected from the policy documents, PAHS website, meeting minutes/ discussions, feedbacks and medial school records. All the information were compiled and presented under different headings/subheadings in a phase wise manner.</p> <p><strong>Result: </strong>PAHS has been actively engaged in a multitude of partnerships from local to global and has chosen the best and most applicable innovations from around the world. The integrated suite of innovations the Academy has developed includes its admission policy, teaching-learning methodologies, community-based learning, scholarship-schemes and service bonds. The PAHS School of Medicine has successfully enrolled undergraduate medical students from all over the country, representing ethnic diversity, remote/rural background, underprivileged communities and gender balance. More than 50% graduates from the first five-batches are successfully deployed into primary level peripheral health facilities of the government health system.</p> <p><strong>Conclusion: </strong>The initial reports and observations confirm that the integrated measures taken by the Academy have been effective in enrolling the right students, educating them in an effective way and deploying them to address the country's need. A longer follow-up on rural retention and performance evaluation is needed to conclusively establish the outcome of the school.</p> Shrijana Shrestha Rajesh Nath Gongal Kedar Prasad Baral Paras Kumar Acharya Bharat Kumar Yadav Jay Narayan Shah Copyright (c) 2022 2022-06-17 2022-06-17 9 1 109 117 10.3126/jpahs.v9i1.44608 Adverse events following Pfizer-BioNTec vaccine against COVID-19 in population more than 12 years of age, Nepal <p><strong>Introduction: </strong>Pfizer-BioNTec vaccine was started in Nepal for the age group of more than 12 y. This study was conducted to find out the adverse event following immunization with Pfizer-BioNTech vaccine against COVID-19 at Patan Academy of Health Sciences (PAHS).</p> <p><strong>Method:</strong> This is a descriptive study conducted at PAHS from November to December 2021. The vaccine recipients were called over the phone after 72 h of receiving the vaccine to find out adverse events following immunization (AEFI). They were inquired about the list of pre-defined AEFI. Ethical approval was obtained.</p> <p><strong>Result: </strong>A total of 1377(27.4%) individuals among 5014 receiving the first dose and 983(71.4%) of 1377 receiving the second dose were enrolled in the study. Vaccine recipients who had minor AEFI in the first dose were 462(33.6%) and in the second dose were 205(20.9%). Reported AEFI in both first and second dose was pain 377(27.4%) and 97(9.9%) respectively, followed by fever in 65(4.8%) and 91(9.3%) respectively. There were no severe AEFI reported in both doses of vaccination. The AEFI started within 24 h and subsided within 72 h.</p> <p><strong>Conclusion: </strong>Minor AEFI of pain and fever was reported with the first and second dose of the Pfizer-BioNTech vaccine. There were no severe and serious AEFI reported in this study population.</p> Ranjan Devbhandari Sumana Bajracharya Sushant Aryal Piyush Rajbhandari Tripti Shakya Mayuri Gupta Shreyashi Tuladhar Binnam Shakya Ashis Shrestha Copyright (c) 2022 2022-04-30 2022-04-30 9 1 5 11 10.3126/jpahs.v9i1.44273 Appropriate citation and accuracy of references: read full text before citing <p>Reference accuracy is important for good science. Cited references must be verifiable and accessible to the readers, reviewers, and editors. When the source cannot be found, it raises question of the quality of the manuscript, and also undermine the credibility of the journal (and editors). Almost all the domains of peer-reviewed medical journal literature report errors in referencing and citations which affect indexing, abstracting, and publication metrics. Citation is properly referring to information presented by others’ and provides authenticity to own work by directing readers to the sources.</p> Jay Shah Copyright (c) 2022 2022-06-17 2022-06-17 9 1 1 4 10.3126/jpahs.v9i1.45539 How to find a predatory journal: prevent yourself from getting scammed <p>Jaffrey Beall defined predatory journals and created Beall’s list of predatory journals. Predatory journals exploit the open-access model - they are dishonest and lack transparency. Predatory journals fully developed in the years 2013 and 2014. Developing countries like South Asian and African countries with emerging research fields have the majority of authors published in predatory journals. Predatory journals are even found in reputed databases like PubMed, Medline, Scopus, Science Citation Index Expanded (SCIE) database, Emerging Sources Citation Index (ESCI), and EMBASE (Excerpta Medica dataBASE). There are numerous fake profiles in Facebook, LinkedIn, Twitter, WhatsApp, and Google; although they have been timely deleting such fake profiles. Journals must use institutional email addresses to maintain professionalism and quality. Focusing on quantity over quality of research papers, and lack of proper knowledge about predatory journals make new researchers victimized by such journals. This paper aims to provide proper knowledge about predatory journals and deliver useful tips to prevent genuine researchers from getting victimized by such journals. This paper also intends to provide thorough knowledge about fake social media accounts and email addresses used by such journals, and the importance of institutional email addresses.</p> Sanjib Koirala Bibek Raj Parajuli Unnayan Baskota Yogendra Poudel Manika Dongol Kishan Shrestha Abishek Bajracharya Saraswoti Khatri Copyright (c) 2022 2022-06-17 2022-06-17 9 1 118 127 10.3126/jpahs.v9i1.44307 Does method of closure effect cesarean wound healing? Stapler versus absorbable sub-cuticular closure done in a tertiary hospital, Nepal <p><strong>Introduction</strong>: Postoperative wound complications for women undergoing cesarean delivery constitute a major cause of morbidity. Data on wound healing based on the type of cesarean wound closure is limited. In this study, we assess the outcome of stapler versus absorbable sub-cuticular suture for skin closure of the cesarean wound.</p> <p><strong>Method:</strong> Prospective observational study. All cesarean section patients during the period of six months (Dec 2019 to May 2020) at Patan Hospital, Nepal, whose skin closure was done by sub-cuticular suture or stapler technique were recruited in the study. Ethical approval was obtained. These patients were followed up postoperatively on the 10<sup>th</sup> day for wound outcome (redness, edema, hematoma, seroma, discharge, gaping). Number and proportion were calculated, chi-square test, and Fisher’s exact test at 95% confidence interval were used to see the association and p&lt;0.05 was considered significant.</p> <p><strong>Result:</strong> Out of 379 patients, 26(6.9%) were lost to follow-up. Among 353 patients, an unhealthy wound was seen in 7(1.98%) during follow-up. Of these unhealthy wounds, closure with stapler technique was 5(71.4%) and by sub-cuticular technique, 2(28.6%), statistically significant with a p-value of 0.014.</p> <p><strong>Conclusion:</strong> Cesarean wound closure by sub-cuticular technique had a better wound outcome compared to closure by staplers.</p> Reena Shrestha Binita Pradhan Sarada Duwal Shrestha Anagha Pradhan Malla Copyright (c) 2021 2022-01-07 2022-01-07 9 1 18 24 10.3126/jpahs.v9i1.28869 Dexmedetomidine as an adjunct to bupivacaine and xylocaine with adrenaline in ultrasound guided supraclavicular brachial plexus block in upper limb surgeries <p><strong>Introduction</strong>: Supraclavicular brachial plexus block is widely used for perioperative anesthesia and analgesia. Dexmedetomidine is highly selective alpha-2 receptor agonist which provides analgesia, sedation and anxiolysis. Our study aims to evaluate the effect of addtion of dexmedetomidine with bupivacaine and xylocaine with adrenaline in supraclavicular block in upper limb surgeries.</p> <p><strong>Method: </strong>This was a comparative study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal among 44 patients randomly assigned in Group-I (N=22, bupivacaine and xylocaine with adrenaline 28 ml + dexmedetomidine 2 ml (1 mcg/kg), and Group-II (N=22, without dexmedetomidine) for ultrasound-guided supraclavicular block for upper limb surgeries. The study was approved by institutional review committee. Onset of sensory and motor block, duration of analgesia, demographics, hemodynamic parameters, and side effects of drug were compared.&nbsp; Pin-prick test and modified Bromage scale were used to evaluate sensory and motor block. Visual analogue scale was used for severity of pain. Statistical analysis was performed with SPSS v.16.</p> <p><strong>Result:</strong> The median time for onsets of sensory and motor block were significantly shorter in group I (1 m and 3 m) than group II (5 m and 10 m). The duration of analgesia was s longer in group I (720 m) than group II (360 m). Two patients had bradycardia and one hypertension in dexmedetomidine group whch were managed successfully.</p> <p><strong>Conclusion:</strong> Dexmedetomidine added to local anesthetics significantly prolongs the effect of supraclavicular block in upper limb surgeries.</p> Alisha Shrestha Abhisesh Shrestha Anil Shrestha Roshan Piya Manisha Pradhan Shirish Prasad Amatya Niroj Hirachan Binam Ghimire Copyright (c) 2021 2022-01-07 2022-01-07 9 1 25 31 10.3126/jpahs.v9i1.31127 Spectrum of paediatric surgical cases and their outcome in a tertiary care hospital <p><strong>Introduction</strong>: Paediatric surgical cases has been operated by general surgeon due to lack of paediatric surgeons. Complex cases in neonates and infants is being referred to other centres with paediatric surgical services. This study aims to compare the spectrum of paediatric surgical cases and their outcome before and after availability of paediatric surgeon.</p> <p><strong>Method:</strong> This is the Retrospective study conducted at Patan Academy of Health Sciences over a period of 4 years. Group 1 included surgeries during 1<sup>st</sup> 2 y before and Group 2 during 2<sup>nd</sup> 2 y period after the availability of paediatric surgeon. Ethical approval was obtained. Patient age, sex, diagnosis, operative procedure, type of surgery and outcome data were collected from operative theater register and patients file from medical record section. Data analysis was done using SPSS 16.</p> <p><strong>Result:</strong> Among 1157 cases, 369 cases were in group 1 and 788 in group 2. Male to female ratio was 2.8:1. Laparotomy 270(23.2%) was the most performed inpatient surgery and hernitomy 221(19.1%) in day care. There was total 52(4.5%) neonates, 2(4%) in group 1 and 50(96%) neonates in group 2. Among total cases mortality rate was 8(0.7%) in group 2, due to preterm birth, delayed presentation and septicemia.</p> <p><strong>Conclusion:</strong> Lower GI tract and skin and soft tissue were most common system involved. Laparotomy and incision and drainage were most performed surgery before and after availability of paediatric surgeon. There was 96% increment in neonatal cases (50 v/s 2) after availability of paediatric surgeon. Mortality was 8(0.7%) in group-2 due to delayed presentation and septicemia.</p> Anu Maharjan Prerana Kansakar Niraj Giri Shiva Prasad Sharma Chalise Samyukta KC Saroj Babu Pradhan Sucharita Tuladhar Sanjaya Paudyal Copyright (c) 2021 2022-01-07 2022-01-07 9 1 32 39 10.3126/jpahs.v9i1.31129 Ocular pathology in patients referred to ophthalmology outpatient clinic at tertiary care hospital with headache <p><strong>Introduction</strong>: Headache has multi-factorial causes; many primary or secondary headache disorders have ocular manifestations and benefit from the systematic ocular examination. Physicians at the point of the first contact should therefore be familiar with common ocular pathologies associated with a headache for appropriate referral.</p> <p><strong>Method</strong>: This hospital-based descriptive cross-sectional study was conducted in the Ophthalmology Department of Patan Hospital. All patients with headache as primary symptom and were referred to an ophthalmology clinic for ocular evaluation by other departments were included. The study was done for 15 mo and 354 patients were evaluated for the cause of headache. Findings and diagnoses of consenting participants were recorded and analyzed.</p> <p><strong>Result:</strong>&nbsp;All enrolled patients completed all the study procedures and were analyzed. The majority 61% were in 14-40 years. Homemaker was commonly affected 30.2% followed by students 25.4%. Any form of ocular pathology was detected in 76 % of patients. The majority of patients had no refractive errors (67.8%). Although any form of refractive error was more common in the presbyopia age group there was no statistically significant difference between different age groups. Most patients were orthophoric and only 11% of patients had vergence insufficiency. Among the ocular pathology dry eye, glaucoma suspects were more common.</p> <p><strong>Conclusion:</strong>&nbsp;This study supports the ocular morbidities and headache symptoms are linked very frequently. Good ocular history is needed for appropriate patient referral to a specialist. Correction of a minor degree of refractive error and lubricating eye drop may relieve worrisome headaches for many patients.</p> Ranjana Sharma Dipsikha Aryal Mukesh Kumar Jha Copyright (c) 2021 2022-06-17 2022-06-17 9 1 40 48 10.3126/jpahs.v9i1.33818 Hospital supply of a polymeric enteral nutrition formula amongst inpatients at Patan Hospital, Nepal <p><strong>Introduction</strong>: A retrospective quantitative descriptive study was undertaken to describe the provision of a standard polymeric nutritional supplement produced at Patan Hospital, Nepal, with the aim of assisting efforts to improve the nutritional care of malnourished patients.</p> <p><strong>Method:</strong> All adult inpatients (18 years and above) who commenced this nutritional supplement between December 2017 and August 2019 were included. Data was collected from a register and descriptive analysis done. The use across specialty areas, patient weights, duration of use, main feeding route, main volume recommended and main reasons for cessation were among the characteristics described.</p> <p><strong>Result:</strong> Total 894 record of the patients were analysed. Awareness-raising activities and launch of a modified supplement recipe, saw prescriptions increase from 13.3 to 47.4 patients per month. The general medical ward and medical intensive care unit initiated the greatest numbers of prescriptions (n=312, n=251 respectively). The nutritional supplement was most commonly prescribed as a 500 ml oral supplement.&nbsp; The average length of prescription was 9.8 d and the main reasons for ceasing was discharge (n=479) and patient expiry (n=158). Weight was recorded in 38% of patients (n=340) and mean weight was 50.5 kg. The average age of the study population was 57.8 y.</p> <p><strong>Conclusion:</strong> For improving the nutritional care of malnourished patients, awareness raising activities appeared helpful in increasing prescriptions for the nutritional supplement. However, the use of the nutritional supplement remained low and practices varied significantly between wards.</p> Bishnu Prasad Sharma Vicki Leanne Kim Copyright (c) 2022 2022-06-17 2022-06-17 9 1 49 57 10.3126/jpahs.v9i1.43893 CT KUB evaluation of suspected urolithiasis <p><strong>Introduction</strong>: Non-contrasted computed tomography scan for kidney, ureter, and bladder (CT KUB) for diagnosis of urolithiasis is important for accurate diagnosis, followup, and management. Unlike USG, CT KUB has more diagnostic yield in urolithiasis and other incidental findings. This study aims to evaluate the use of the CT KUB in suspected urolithiasis, presented with severe flank pain.</p> <p><strong>Method: </strong>A retrospective observational study was carried out in the Department of Radiology and Imaging, Patan Hospital, Nepal.TheCT KUB reports of patients with suspected urolithiasis from a period of 3 years from Jan 2017 to Jan 2020 were analyzed for evidence of urolithiasis and secondary signs of obstruction as ‘diagnostic’ of CT KUB. Other incidental radiological findings were further analysed and categorized into urinary and extra-urinary. Ethical approval was obtained.Association of USG and CT KUBwas analysed using Chi-square test,with&nbsp; p value&lt;0.05considered statistically significant.</p> <p><strong>Result: </strong>Total of 414 CT KUB reports were analysed, 230(55.6%) males, 314 patients had USG before CT KUB. Considering CT KUB as a gold standard for diagnois of urolithiasis, the accuracy of ultrasound was found to be 85.03% and sensitivity is 94.09% and specificity of 27.9%.</p> <p><strong>Conclusion:</strong> &nbsp;Majority of the patients included in the study had ultrasound done before CT KUB. The sensitivity of ultrasound was significant considering CT KUB as a gold standard in diagnosis of urolithaisis.</p> Pooja Jaiswal Shreejana Shrestha Yogita Dwa Dinesh Maharjan Ngawang Temba Sherpa Copyright (c) 2022 2022-06-17 2022-06-17 9 1 58 64 10.3126/jpahs.v9i1.43895 Accuracy of magnetic resonance cholangiopancreaticography in the diagnosis of benign and malignant cause of obstructive jaundice <p><strong>Introduction:</strong> Obstructive jaundice is one of the most common hepatobiliary diseases. Though USG is very good screening and diagnostic tool for obstructive jaundice its role is limited in gaseous abdomen, recent meal and patient’s body habitus. ERCP has very high accuracy in diagnosis of biliary disease especially choledocholithiasis and CBD stricture. Since ERCP is minimal invasive procedure with certain morbidity and mortality risk MRCP is standard technique for overall assessment of obstructive jaundice. This study aims to compare diagnostic accuracy of MRCP in diagnosing benign and malignant cause of obstructive jaundice taking HPE and ERCP as Gold standard.</p> <p><strong>Method:</strong> This was a retrospective study reviewing MRCP findings of clinically diagnosed obstructive jaundice from 2018 to2021 at Patan Hospital, Kathmandu Nepal. Study was conducted after ethical clearance of the institutional review committee.</p> <p><strong>Result:</strong> Among 66 patient Sensitivity, Specificity, PPV and NPV of MRCP for biliary obstruction due to malignant pathology were 89.50%, 93.60%, 85.00% and 95.70% respectively. Similarly for benign etiology, Sensitivity, Specificity, PPV and NPV accounted for 93.60%, 89.50%, 95.70% and 85.00% respectively. The overall diagnostic accuracy was 92.40%. Choledocholithiasis&nbsp; was the most common benign cause of obstructive jaundice 31 (46.97%) cases, while periampullary carcinoma was the most common malignant cause eight (12.12%).</p> <p><strong>Conclusion:</strong> MRCP is highly sensitive and specific test in the evaluation of benign and malignant biliary pathology. Being noninvasive and can have good diagnostic value despite use of contrast. So minimally invasive procedure ERCP can be reserved for therapeutic or diagnostic biopsy purpose only.</p> Ngawang Temba Sherpa Sagun Manandhar Anil Karki Prabhat Karki Copyright (c) 2022 2022-06-17 2022-06-17 9 1 65 71 10.3126/jpahs.v9i1.43896 Factors influencing knowledge and behaviors related to food safety during purchasing among consumers in Libya <p><strong>Introduction:</strong> Libyan consumers mainly rely on purchasing food products and preparing them at home. Therefore, knowing the rules of food safety when purchasing is key to protect them from foodborne diseases. This study aims to assess food safety knowledge and behaviours during purchasing among consumers in Libya.</p> <p><strong>Method:</strong> The study was carried out through the internet by Qsurvey and filling paper questionnaires by self-administration method to explore the level of food safety knowledge and practices during purchasing among consumers in Libya, from March to December 2020. Data were analyzed by SPSS. A Chi-square test was used to determine the influence of demographics on the level of knowledge and behaviours. Bivariate correlation coefficient analysis was used to determine the correlation between knowledge and behaviours scores. A p value of &lt;0.05 was considered statistically significant.</p> <p><strong>Result:</strong> There was a total of 1027 consumers surveyed. A good level of food safety knowledge was found in 531(51.7%) and the level of food safety behaviours was moderate in 684(66.6%). The age and monthly income influence food safety knowledge (P&lt;0.05) while gender and age influence food safety behaviour during purchasing (P&lt;0.05).</p> <p><strong>Conclusion:</strong> The level of food safety knowledge was good and the level of behaviours was only moderate. Therefore, there is a need to raise awareness of the population related to food safety.</p> Thuraya Ahmed Abuhlega Aya Anwar Abduljalil Copyright (c) 2022 2022-06-17 2022-06-17 9 1 72 81 10.3126/jpahs.v9i1.44305 Awareness and preventive practice regarding osteoporosis among women in a community, Lalitpur <p><strong>Introduction:</strong> Osteoporosis is a major public health problem globally that can break a bone from a minor fall, or even from simple actions like sneezing. This study sim to assess the awareness and preventive practice of osteoporosis among community women.</p> <p><strong>Method:</strong> An analytical cross-sectional study was conducted. The multistage sampling technique was used to select the sample from women 18-65 years from ward no. 16 of Lalitpur, Kathmandu, Nepal. Data were collected by using a semi-structured questionnaire to obtain socio-demographic variables. The Osteoporosis knowledge assessment tool (OKAT) and Osteoporosis Knowledge tool (OKT) were modified to assess the level of awareness and the Likert scale was used to assess the level of preventive practice. The SPSS 16 was used for analysis. The association and correlation between variables were measured by chi-square and Pearson correlation coefficient respectively.</p> <p><strong>Result:</strong> The majority 167(74.2%) of the respondents had an adequate level of awareness. The awareness had a statistically significant association with educational status (p=0.042). More than half 119(52.9%) of respondents had a poor level of preventive practice. There is a low but significant positive correlation between the level of awareness and level of total preventive practice (r = 0.251).</p> <p><strong>Conclusion:</strong> There was an adequate level of awareness among respondents, but had a poor level of preventive practice. There was a low but positive correlation between awareness and preventive practice.</p> Rachana Shakya Copyright (c) 2022 2022-06-17 2022-06-17 9 1 82 91 10.3126/jpahs.v9i1.44304