Journal of Nobel Medical College

Prediction of Stone Free Rate after Standard Percutaneous Nephrolithotomy using Stone Nephrolithometry Score in Nobel Medical College Teaching hospital – A Prospective Study

2023-07-02T06:54:41+00:00

Background: Amongst all the modalities of treatment for renal stones, percutaneous nephrolithotomy is preferred treatment for large volume renal stone disease. However, percutaneous nephrolithotomy is associated with the risk of postoperative complications and the problem of stone free status. So, a preoperative classification is necessary to grade the complexity of percutaneous nephrolithotomy and STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) nephrolithometry score is one of such kind.

Materials and Methods: This is analytical study conducted at the Department of Urology and Kidney Transplant, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal from January 2020 to July 2020. Total 115 patients were included in the study. These patients were subjected for percutaneous nephrolithotomy. Stone clearance was documented at the end of the surgery; on first postoperative day and at 4 weeks.

Results: In our study the stone – free rate was 89.6%. 32 patients experienced complications (27.8%). The STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) score correlated with the postoperative stone – free status (P=0.001). The patients rendered stone free had statistically significant lower scores than the patients with residual stones (6.83 ± 1.83 vs 9.83 ± 2.08, P = 0.001).

Conclusion: The STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) nephrolithometry score is a simple and easy tool to apply system for predicting complexity in stone clearance with percutaneous nephrolithotomy.

Pattern of Drug Prescription in Patients with Chronic Kidney Disease Maintained on Hemodialysis in a Tertiary Care Hospital

2023-07-03T01:05:14+00:00

Background: Chronic kidney disease affects the structure and function of the kidneys over a specific period of time. It is a worldwide public health related problem. It is usually associated with increasing age, hypertension, diabetes, cardiovascular disease and lack of exercise.

Materials and Methods: It was a cross-sectional observational study conducted at Nobel Medical College Teaching Hospital. A total 150 patients were enrolled in this study from March 2021 to February 2022. Patients aged 18 years and above diagnosed with chronic kidney disease and treated with dialysis were included in this study. Statistical tools were used to describe the relevant data.

Results: Chronic kidney disease was more predominant among males 90 (60%) than females 60 (40%). Thecommon co-morbid conditions were hypertension 51(34%) followed by hypertension & diabetes 40 (26.66%). 115 (76.66%) patients were receivinghemodialysis twice followed by 26 (17.33%) who were receiving it thrice a week. An average of 7.03 drugs per prescription was advised. Commonly used drugs were hydrocortisone 145 (96.66%), torsemide 90 (85.71%), and vitamin D₃ 105 (75%). Among the complications, the most commonly occurred were chills & rigor 15 (10%) followed by backache 12 (8%).

Conclusion: Hydrocortisone, torsemide and Vit.D_3,were prescribed medications in CKD patients maintained on hemodialysis. Hydrocortisone was commonly used at this tertiary care hospital. Chills & rigor and backache were complication occurred during hemodialysis.

Sex Differentiation from Fingerprint Ridge Density

2023-07-03T01:14:45+00:00

Background: Determination of sex is an important parameter other than age, race and stature during forensic identification and crime scene investigation. Females tend to have finer and denser ridges on their fingertips than males. Present study aims at differentiating gender from fingerprint ridge density.

Material and Methods: This is a cross sectional study conducted from March 2022 to March 2023 in Nobel Medical College Teaching Hospital, Nepal. Seven hundred fingerprints samples (350 males and 350 females), from 70 Nepalese medical students were collected and analyzed for gender differences. Comparative analysis was done using Student’s t-test (p<0.05). Likelihood ratio and posterior probability using Baye’s theorem were calculated to interpret the possibility of gender differentiation from various fingerprint ridge densities.

Results: Students t-test revealed significant difference (p < 0.001) between the fingerprint ridge density of male and female (t= -16.733). The results showed ridge density <14/25mm²and >15/25mm²are “more likely than not” from males and females respectively. Posterior probability using Baye’s theorem further revealed ridge density <13/25mm²(C/C¹=5.75,P=0.86) and >16/25mm²(C¹/C=4.29, P¹=0.84) have higher probability of originating from males and females respectively. No any male and female had ridge density >16/25mm²and <13/25mm²respectively.

Conclusion: The study revealsstatistically significantlygreater fingerprint ridge densities in female than in male Nepalese medical students.

Evaluation of Prescription Pattern of Analgesics at Emergency Department of Tertiary Care Hospital: A Descriptive Cross-Sectional Study

2023-07-03T01:23:03+00:00

Background: Rational use of analgesic drugs is needed for immediate relief of pain. This study was conducted to find out the prescribing pattern of analgesics in the emergency department.

Materials and Methods: A descriptive cross-sectional study among patients attending the emergency department of a tertiary care hospital from March 2022 to February 2023 after approval from the Institutional Review Committee. Demographic profile, indications for analgesics use, route, and frequency of administration were recorded based on the pre-structured questionnaires. Convenient sampling was done. Data were analyzed by using SPSS, version 20.

Results: Prescription patterns of analgesics were analyzed in 325 patients. The mean age was 46.93 ± 17.79 years with a male predominance of 196 (60.6%). Orthopedic problems 99(30.5%) due to trauma were the most common indications followed by medical and surgical indications for analgesic use. Non-steroidal anti-inflammatory drugs were used in 46.6%, opioids in 26.8%, combinations in 23%, and antispasmodics in 3.6%. Commonly prescribed analgesic was ketorolac (27.4%), tramadol (19.7%), and diclofenac (11.4%). The most common combination was ketorolac and tramadol (14.5%). Paracetamol alone was used in 16 (4.9%). A prescription with a generic name was 149 (45.8%). Parenteral use accounted for 86.8%. Co-administration of gastroprotective drugs was used in 93.2%. A fixed-dose combination was used in 1.2%.

Conclusion: Non-steroidal anti-inflammatory drugs are the commonly used analgesics for various indications, including acute pain and fever. The choice of analgesics and their prescription pattern varied depending on indications, medical history, and the presence of co-morbidities. Ketorolac and tramadol were the most commonly prescribed analgesics.

Outcome of Lung Functions in Covid-19 Patients at a Tertiary Care Center of Eastern Nepal

2023-07-03T02:24:48+00:00

Background: Novel coronavirus infection has myriad clinical manifestations, such as headache, respiratory failure, and long coronavirus disease syndrome. A common cause for admission is pneumonia, and such patients have shown longer periods of respiratory symptoms and exercise intolerance after discharge. The study aimed to determine short-term and long-term lung function outcomes in coronavirus disease patients.

Materials and Methods: The prospective, cross-sectional study was conducted in coronavirus disease facility of Birat Medical College Teaching Hospital. A structured proforma including symptoms, modified medical research council dyspnea scale, 6-minute walk test and portable spirometry were recorded during 3 months follow up.

Results: A total of 58 coronavirus disease patients were admitted, 4 expired. Common symptoms were dyspnea (98.28%), fever (94.8%), dry cough (86.2%), myalgia (17.2%). Mean Forced expiratory volume in 1 second to forced vital capacity ratio was normal. The mean forced vital capacity was 46.52% at admission, 53.33% at 3 months. The mean forced expiratory flow at 25% to 75% of forced vital capacity was 56.91% at admission, 59.31% at 3 months. Mean values of forced expiratory volume predicted was 47.40% at admission, 51.69% at 3 months. Mean 6-minute walk test distance did not improve during follow-up (240.09m at 1 month, 239.35m at 3 months) and there was no improvement in oxygen saturation at 3 months compared to the first month.

Conclusion: Short-term lung function outcome demonstrated persistent dyspnea and development of mixed airways disease in all the survivors. Long-term lung function outcome observed was persistence of dyspnea, mixed airways disease, and low exercise capacity.

Clinico-Epidemiological Profile and Outcome of Poisoning in Children Presenting at a Tertiary Care Hospital of Eastern Nepal

2023-07-03T06:11:11+00:00

Background: Pediatric poisoning is common emergency worldwide and represents major and preventable cause of morbidity and mortality in children. The study describes epidemiology and outcome of acute poisonings in children presenting to Nobel Medical College through Emergency and Outpatient department and determines causative agents and characteristics of acute poisoning in several pediatric age groups.

Material and Methods: This was hospital based prospective cross-sectional study which included all acutely poisoned patients under 18yrs age of either sex who presented to Nobel Medical College Teaching Hospital during 1year period (January 2021 to December 2021). Various socio-demographic variables, poisoning details, clinical manifestations, treatment given, outcome and complications were entered in predesigned proforma. Data was entered in excel sheet and descriptive analysis was done using SPSS software (version 20).

Results: During the study period total 56 children with poisoning were admitted and enrolled. The mean age (±SD) of children with poisoning was 8.18 ± 5.50 Years. Poisoning cases werepredominant in male children (n=56, 53.6%). The most common poison wasorganophosphates(OP) compounds (41.1%). More than three-fourth of cases (92.9%) were symptomatic where nausea/vomiting (78.6%) was most common clinical symptoms, About 83.9% children survived, 10.7% expired and 5.4% left against medical advice (LAMA). Complications were seen in about 37.5% where shock was most common complications

Conclusion: Poisoning was common in adolescent age group.Overall nature of poisoning was accidental however, in adolescent age group majority of them were suicidal in nature.Organophosphates (OP) compounds was most common type of poisoning

Perception Regarding Respectful Maternity Care among Postnatal Mothers at Tertiary Centre Hospital, Koshi Province

2023-07-03T06:19:40+00:00

Background: Pregnancy and childbirth are momentous events, with deeply personal and social significance in the lives of women, families, and communities. Around the world, in every country and community, pregnancy and childbirth are immensely important events in the lives of women and families. So, the study aimed to assess the perception regarding respectful maternity care among postnatal mothers.

Materials and Methods: A cross-sectional study was conducted among postnatal mothers at Tertiary Centre Hospital in Koshi Province. The study was started after acquiring approval from the Institutional Review Committee of Nobel Medical College. Data was collected using a face-to-face interview technique with a standardized tool from June 2022 to September 2022. A total of 102 postnatal mothers were taken as a sample by using a non-probability purposive sampling technique. Data analysis was done by descriptive study.

Results: A total of 102 respondents participated in the study of which 62.7% had received overall dimensions of experienced Respectful Maternity Care (RMC) with a mean score ± SD (51.91 ± 5.56). Likewise, among the four dimensions of RMC, the highest average mean score of 81.96 is observed in the discrimination-free care with an SD of 11.08, where 100 % of the women claimed being received discrimination-free care.

Conclusion: There was a significant association of RMC with residence and the number of ANC visits. Even though RMC prioritizes removing disrespectful and abusive settings from healthcare facilities, one-half of participants felt that they had not utilized all of RMC's offerings.

Prevalence and Antibiogram of Bacterial Uropathogens from a Tertiary Care Hospital of Eastern Nepal

2023-07-04T01:21:26+00:00

Background: Urinary tract infection (UTI) is defined as growth of micro-organisms >10⁵ CFU/ml in mid-stream urine samples. [1] Globally, urinary tract infection is considered a major public health concern with the second most common bacterial infection affecting individuals of different ages. It is estimated that worldwide 150 million cases of UTI occur per year and bacteria are responsible for about 95% of all the cases with each year. [3, 4] This study was designed to describe the pattern of microorganisms causing UTI and their antibiotic sensitivity.

Materials and Methods: This is a hospital based cross-sectional study conducted in the Department of Microbiology from January 2022 to June 2022 after taking ethical approval from Institutional Review Committee, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. The patient profiles or records visiting a tertiary care hospital of both sex and every age group who were having symptoms and clinical diagnosis of urinary tract infection were included.

Results: A total of 2247 urine samples were collected, 501(22.29%) of the urine sample yielded significant growth of uropathogenes. The most common bacteria was found to be Escherichia coli (E. coli) that accounts for 73.05% followed by Enterococcus species 11.57%, Klebsiella pneumoniae 8.98% and amikacin and nitrofurantoin was found to be the most sensitive antibiotic to gram negative uropathogens.

Conclusion: The prevalence of uropathogenes was found to be higher in our study. Significant bacteriuria was seen in the female than male. The total number of patient with culture positivity was higher in younger age groups with high frequency of antibiotic resistance

Hyperprolactinemia in Subclinical Hypothyroid Patients at BPKIHS, Dharan

2023-07-04T06:06:23+00:00

Background: Hyperprolactinemia and subclinical hypothyroidism may be associated and are usually accompanied by menstrual disorders in female patients. The objective of this study is to determine the prevalence and association of hyperprolactinemia in subclinical hypothyroidism and the associated clinical features.

Materials and Methods: This is a hospital-based descriptive cross-sectional study conducted from 1 July 2022 to 31 December 2022. Serum Prolactin level was measured in subclinical hypothyroid patients who met the inclusion criteria.Descriptive statistics such as frequency and percentage for categorical variables and mean with standard deviation for quantitative variables were calculated. Pearson’s Chi-square test was used for statistical analysis and the p-value <0.05 was considered statistically significant for analysis.

Results: One hundred and forty-four newly diagnosed subclinical hypothyroid patients were enrolled; the mean age of the patients was 36.95±12.58 years. Female patients comprised 89.6% of the study participants. Hyperprolactinemia was prevalent in 23.6% of subclinical hypothyroid patients (23.4% in TSH 4.5-10 µIU/mL group and 24.3% in TSH >10 µIU/mL group). There was no significant association between subclinical hypothyroidism and prolactin levels.Menstrual irregularities were the most common clinical manifestations which account for 44.2% of female subclinical hypothyroid patients and menstrual irregularities were significantly associated with hyperprolactinemia.

Conclusion: The number of patients with hyperprolactinemia in subclinical hypothyroidism was substantial even though the association between them was not significant. Assessment of serum prolactin may be considered in subclinical hypothyroid patients who present with menstrual irregularities

Quality of Life among Patients with Cardiovascular Diseases at Birat Medical College Teaching Hospital

2023-07-04T06:36:11+00:00

Background: Modern healthcare delivery needs to take care of the quality of life of patients. The burden of cardiovascular disease is increasing each year affecting the quality of life. So, we aimed to examine the quality of life of patients with cardiovascular diseases (CVD) at Birat Medical College Teaching Hospital.

Materials and Methods: A hospital based cross sectional study was conducted among cardiovascular disease patients at Birat Medical College Teaching Hospital from 2023 Jan 27 to 2023 March 27. Ethical clearance was taken from the institutional review committee. The collected data was entered in Microsoft Excel 2019 and analyzed by IBM SPSS statistics 2025.

Results: Among 256 patients, the majority 67(26.2%) were in the age of 61-70 years and male 156(60.9%). Majority 91(35.5%) had coronary artery diseases. The quality of life domains ranging from least to most affected were bodily pain (81.04±26.02), mental health (76.4±15.18), social functioning (68.1±24.2), role limitation due to emotional problems (67.9±43.56), physical functioning (59.02± 28.9), vitality (53.67±15.45), general perception of health (50.19±15.7) and role limitation due to physical health (46.39± 44).

Conclusion: Patients with cardiovascular disease had their quality of life affected based on their physical health, general perception of health, energy and vitality, physical functioning, role limitation due to emotional problems, social functioning, mental health and bodily pain

Professional Values among Undergraduate Nursing Students in Nobel Medical College Teaching Hospital

2023-07-05T05:55:48+00:00

Background: Professional values are the basis to professional nursing practices. Professional values can be challenged by the variety of situation due to increasing globalization, diversity and health variance and can generate ethical dilemmas in health care delivery. Nursing students must be familiar to the professional value of the profession in which they are enrolled to imply the effective care to the patients.

Material and Methods: A descriptive cross sectional study design was done to assess the Professional values among undergraduate Nursing students in Nobel Medical College Teaching Hospital. A total of 119 nursing students were included in the study using total enumerative sampling techniques. Nurses Professional Values Scale (NPVS-3) was used to assess professional values among the Nursing Students. The data were analysed using SPSS version 23. For descriptive statistics frequency, percentage, mean and standard deviation was calculated and for inferential statistics Pearson’s correlation test was used.

Results: The total mean score of professional values from the nursing student’s outlook was high (115.24 ± 13.50) and also it reveals that 51.3% of the nursing students were conscious of professional values about nursing profession. The mean score was high (42.34 ±5.11) on caring sub-dimension than Activism and Professionalism. There was statistically significant relationship between the total score of professional values with Age.

Conclusion: Findings of the study showed that the overall nursing professional value was high and the mean score was high on caring sub-dimension whereas professionalism and activism has been given less importance by the nursing students in comparison with caring domain.

Analysis of Neonatal Admission Patterns and Clinical Profiles in a Tertiary Care Center: Focus on Neonates Transferred from the Delivery Room to the Neonatal Intensive Care Unit

2023-07-06T05:57:18+00:00

Background: Neonatal mortality rate is very high in developing countries despite of advancement in perinatal and neonatal care with reduced neonatal mortality rate in many developed countries. This study aims to identify the reasons of admitting neonates for intensive care after vaginal delivery and their outcome.

Materials and Methods: This is an observational descriptive study conducted for over a year at Nobel Medical College Teaching Hospital which included newborns delivered vaginally within the hospital. Demographic data of newborn and mother was obtained, birth weight, reason for admission and final outcome were documented. Outcomes were classified as improved with recovery, mortality and discharge on request prior to recovery. Descriptive statistics such as mean, percentage and standard deviation were obtained.

Results: Total 117 neonates were admitted to intensive care out of 3452 vaginal deliveries with male to female ratio of 1.9:2. There were 60 (51.3%) preterm, 55 (47%) full term and 2 (1.7%) post term; and 68 (58.1%) were low birth weight. Prematurity with respiratory distress syndrome was the most common cause of admission (34.2%) along with birth asphyxia (29, 24.8%) and meconium aspiration syndrome (20, 17.1%). Positive Airway Pressure was required in 42 (35.9%). Blood Culture positive growth was seen in 17.9% with most common organism being Staphylococcus aureus. Mean stay was 3.75±2.49 days andmortality in the study population was 6.8%.

Conclusion: Prematurity with respiratory distress syndrome, birth asphyxia and meconium aspiration syndrome were major indications for admission of newborns delivered via vaginal deliveries to neonatal intensive care unit. One-fourth required mechanical ventilation.

Knowledge Regarding Evidence-Based Guidelines on Ventilator-Associated Pneumonia Prevention Bundle among Critical Care Nurses

2023-07-06T06:08:29+00:00

Background: In critical care units, ventilator-associated pneumonia is still a frequent and possibly fatal consequence of ventilator therapy. Choosing the most urgent care and knowing how to prevent ventilator-associated pneumonia may help nurses become more alert, which will improve the quality of care and prevent a serious problem in Nepal. Thus, this study aimed to assess the knowledge regarding evidence-based guidelines on ventilator-associated pneumonia prevention bundle among critical care nurses.

Materials and Methods: Data were collected through a self-administered structured questionnaire using the non-probability total enumerative sampling technique among 132 critical care nurses. Data analysis was carried out using SPSS version 20. For descriptive statistics frequency, percentage, mean, and standard deviation were calculated. For inferential statistics, the Chi-square test was used to find out the association between the levels of knowledge regarding Evidence-Based Guidelines on the VAP Prevention Bundle among Critical Care Nurses.

Results: One hundred and thirty-two critical nurses participated in this study. 51.5 % had a poor level of knowledge, whereas, 45.5 % had an average level of knowledge and only 3.0 % had a good level of knowledge. There was a statistically significant association between the level of knowledge and the respondents’ working experience.

Conclusion: According to the study's findings, the majority of respondents had inadequate knowledge. Regular formal training and interactive educational sessions are required to evaluate knowledge of the VAP prevention bundle, particularly in light of the high nurse turnover rate.

A Comparative Study of the Safety and Efficacy of Amlodipine and Enalapril when Prescribed as Monotherapy in Patients with Isolated Systolic Hypertension

2023-07-06T06:18:06+00:00

Background: Most elderly patients with high blood pressure have isolated systolic hypertension. Enalapril and amlodipine are respectively the most commonly prescribed ACE inhibitors and calcium channel blockers in Nepal. The goal of the current study was to compare the adverse drug reaction associated with amlodipine and enalapril in the study population as well as to compare the mean blood pressure and pulse rate reductions caused by amlodipine and enalapril in isolated systolic hypertensive patients.

Materials and Methods: A comparative cross-sectional study was performed on 72 patients of both genders within the age group of 30 to 90 years; with isolated systolic hypertension; attending the out-patients department of Medicine of Nobel Medical College and Teaching Hospital; from December 2022 to February 2023. Mean reductions in systolic and diastolic blood pressure in the two treatment groups over the eight-weeks study period was calculated and then compared. Frequencies of patients developing different side effects was also calculated and compared between the two groups.

Results: Systolic blood pressure was reduced by 16.1% in amlodipine group and by 18.8 % in enalapril group. Enalapril was slightly more efficacious in reducing the systolic blood pressure but such changes were found to be of no significant difference when compared between the two groups. (p > 0.05). The incidence of adverse effect was more in the amlodipine group in comparison to the enalapril group. Dry cough, dizziness, headache and fatigue with enalapril; and headache, peripheral edema, shortness of breath, fatigue, and flushing and dizziness with amlodipine were the common adverse effects.

Conclusion: Both amlodipine and enalapril were equally effective in lowering systolic blood pressure without significantly lowering diastolic blood pressure. They were also generally well tolerated, though amlodipine was slightly more likely to cause side effects.

Port Site Infection after Elective Laparoscopic Cholecystectomy with or without the Use of Prophylactic Antibiotics: A Comparative Cross-Sectional Study

2023-07-10T06:40:23+00:00

Background: Laparoscopic surgery, a minimally invasive procedure, has gained popularity due to early recovery rate and minimal incision. Port site infection following laparoscopic surgery is an infrequent complication, increasing patient's morbidity, and also damaging surgeon's reputation. It depends on sterilization and surgical techniques, which have improved with time. The aim of this study is to evaluate the role of prophylactic antibiotics in preventing port site infection after laparoscopic cholecystectomy.

Materials and Methods: A comparative cross-sectional study on 200 patients undergoing elective laparoscopic cholecystectomy was conducted from November 2021 to February 2022 in tertiary care Hospital by using systematic random sampling.Among the 200 patients, 100 odd numbered patients were given antibiotics, and 100 even numbered patients were not. The outcome of the two groups was measured with regard to port site infection.

Results: The mean age in prophylactic antibiotic receiving group and not receiving group was 42.13 (SD = 14.41) and 42.71(SD = 14.29) years, respectively. The female: male ratio for total patients was 2.77.There were three cases of port site infection in total, in group receiving antibiotics (Cefotaxime), there was one case, whereas in placebo group, there were two. Simple logistic regression was utilized to compare the results of two groups (p>0.05). Similarly, Chi-square test was applied to histopathology diagnosis, which showed no statistically significant difference (χ2 = 0.99, P = 0.80).

Conclusion: Antibiotic prophylaxis does not lower the rate of infectious in patients undergoing elective laparoscopic cholecystectomy.

Isolated Short Femur Length in the Third Trimester

2023-07-10T06:51:05+00:00

A short femur length (FL) has been defined as the presence of a biometric value of fetal FL below the 5th percentile or −2 standard deviations (SD) for gestational age at ultrasound examination. A short FL was also defined as a biparietal diameter to FL ratio above 1.5 SD for gestational age or as observed to expected FL ratio ≤0.91 for gestational age. Short FL was considered isolated when both the estimated fetal weight and abdominal circumference were >10th percentile for GA. Here, we report a case of a pregnant patient with isolated short FL of fetus in third trimester ultrasound exam.

Asymptomatic Diabetes Insipidus Detected after Partial Pneumonectomy of Upper Left Lobe of Lung Diagnosed with Adenocarcinoma: An Unusual Case Report

2023-07-11T01:42:27+00:00

We present a case of 80 years woman chronic smoker (10 cigarettes)/ per day for 50 years diagnosed with adenocarcinoma in the upper left lobe of her lungs in a geriatric clinic. She has no history of diabetes but taking medicine for hypertension and dyslipidemia. She was admitted and operated on for partial pneumonectomy and discharged after 11 days of care with all essential drugs, and instructions. After 4 weeks of treatment, she complained of unusual polyuria, diagnosed in the department of Geriatrics, Zhongnan Hospital of Wuhan University, China.

Hospital Waste Management- Are We Doing it in the Correct Way?

2023-07-02T05:34:28+00:00

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