Journal of Nobel Medical College

Duty Bearers and Care Seekers

Gehanath Baral — Sun, 31 Dec 2023 00:00:00 +0000

Health care systems and businesses have a common format of service delivery to the customer. Both internal and external customers are there and the difference is in the urgency, degree of continuity of care, and sensitivity of issues. Motivation of internal customers and satisfaction of external customers are the key elements of success. The service system is described as a Four-block service system.

Root Dentin Transparency: A Reliable Method of Age Estimation in Nepalese Population

Sun, 31 Dec 2023 00:00:00 +0000

Background: Root dentin transparency, one of the age changes in dentin, is considered to be a stable parameter not affected by environmental and pathological factors. The effect of age changes in the transparency of root dentin in Nepalese population have not been established so far. In the present study, we aimed to determine the age of an individual using the root dentin transparency in the Nepalese subjects and attempt to derive the formula to estimate the age applicable to the Nepalese population.

Materials and Methods: A cross sectional analytical study was conducted to measure the length of root dentin transparency in the tooth of patients of known age. Correlation of the age and the length of transparent root dentin was determined. A linear regression analysis was carried out to derive a formula applicable to the Nepalese population.

Results: The length of transparent root dentin increased linearly with the age of an individual. The newly derived formula was used to calculate the estimated age from the length of transparent root dentin. The difference between the actual age and the calculated age was within 6 years in 63.2% of the sample.

Conclusion: A simple and relatively inexpensive method for calculating age by measuring RDT is described.

Laser Hemorrhoidoplasty for Treatment of the Hemorrhoids in Eastern Nepal

Sun, 31 Dec 2023 00:00:00 +0000

Background: Millions worldwide are affected by hemorrhoids (prevalence 2.9%-27.9%), causing symptoms in over 4% of individuals. These anorectal disorders result from enlarged anal hemorrhoidal cushions, often due to constipation. Internal or external, they're graded by prolapse severity, with common symptoms including painless rectal bleeding. Treatment options range from conservative to surgical, with the gold standard, Milligan-Morgan hemorrhoidectomy, associated with postoperative pain. Laser hemorrhoidoplasty, a minimally invasive diode laser approach, shows promise, offering less postoperative pain, shorter hospital stays, and fewer complications than traditional surgical methods.

Materials and Methods: A prospective observational study of 40 adults undergoing laser hemorrhoidectomy for symptomatic Goligher’s grade II and III hemorrhoids at Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from June 2022 to June 2023. Outcomes included pain scores, bleeding, operative time, postoperative complications, hospital stay length, return-to-work time, and patient satisfaction measured by QOL SF36 scoring.

Results: Among 40 patients, 16 were male and 24 females, averaging 42.32 ± 12.26 years. Grade III hemorrhoids were found in 31 patients, Grade II in 9. Operative time averaged 17.22 ± 2.14 minutes, with one case of managed intraoperative bleeding. Postoperative symptoms included pain, skin tags, and wound infection, but no reactive bleeding, urinary, or stool/flatus incontinence. Two cases experienced recurrence. Patient satisfaction in general health evaluation scored 65.11 ± 10.35.

Conclusion: Laser hemorrhoidoplasty is associated with less complications, quicker operative time, quick recovery and similar patient satisfaction when compared to surgical methods of hemorrhoidectomy.

Diagnostic Utility of Touch Imprint Cytology of Image Guided Core Needle Biopsy

Mona Dahal, Smriti Karki, Niraj Regmi, Karun Devkota, Neetu Jain — Sun, 31 Dec 2023 00:00:00 +0000

Background: Touch imprint cytology of image guided core needle biopsy implies gentle rolling of core needle biopsy obtained with the aid of imaging modality from various organs. The aim of the study was to measure the diagnostic accuracy of touch imprint cytology of image guided core needle biopsy in comparison to histopathological diagnosis.

Materials and Methods: A prospective descriptive cross-sectional study was conducted among 47 touch imprint cytology of image guided core needle biopsy in the department of pathology of a tertiary care centre between 1^st October 2021 to 30^th September 2022 after receiving ethical approval from the institutional review committee. The Papanicolaou and Giemsa-stained slides of touch imprint smear and haematoxylin - eosin-stained slides of core needle biopsy was analysed for adequacy and categorization as non-neoplastic, benign, atypical and malignant. Convenience sampling was done.

Results: The most frequent site of image guided core needle biopsy was lung (40.4%). The adequacy rate of touch imprint cytology of image guided core needle biopsy was 85.1%. Among 40 cases of adequate touch imprint smear, 28 cases (70%) were categorized as malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of touch imprint cytology for categorizing a malignant lesion was 91.18%, 95.45%, 96.88%, 87.5% and 92.86% respectively.

Conclusion: The touch imprint cytology of image guided core needle biopsy is a useful modality for the rapid preliminary diagnosis of lesions of various organs with decreased turnaround time for diagnostic workup and ancillary studies.

Immediate Outcomes in Neonates Born to Diabetic Mothers

Vijay Kumar Sah, Sunil Kumar Yadav, Arun Giri, Sandip Kumar Singh — Sun, 31 Dec 2023 00:00:00 +0000

Background: Infants born to diabetic mothers are at a higher risk of developing complications like macrosomia, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia, prematurity, transient tachypnea of newborn, respiratory distress syndrome, birth asphyxia, congenital heart diseases etc. The predominant causes of mortality are congenital anomaly, birth trauma, respiratory distress syndrome, prematurity and unexplained still birth. Hence this present study was conducted to study the incidence of complications among neonates of diabetic mothers.

Materials and Methods: This was hospital-based observational study conducted in NICU and postnatal ward of a tertiary care hospital among 55 neonates. A detailed maternal history and complications during labor were recorded. Investigations like glucose estimation, PCV, serum calcium, serum bilirubin were done. The incidence of complications was assessed in terms of frequency and percentage.

Results: Complications related to maternal diabetes were observed among 33 (18.15%) neonates. They were hypoglycemia, hypocalcemia, hyperbilirubinemia and polycythemia. Among them, hypoglycemia was the most common complication observed among 13(23.63%) neonates followed by hyperbilirubinemia among 10 (18.18%) neonates.

Conclusion: Hypoglycemia was the most common complication followed by hyperbilirubinemia among infants born to diabetic mothers.

Prevalence of Depression and Anxiety Symptoms among Patients with Hypothyroidism in a Tertiary Care Centre

Mukti Acharya, Deepak Karki, Surendra Prasad Shah — Sun, 31 Dec 2023 00:00:00 +0000

Background: The correlation between depression, anxiety and thyroid function is widely recognized. These conditions exhibit numerous similar symptoms, which complicates the process of diagnosing and treating them. The aim of this study is to determine the frequency of Anxiety Symptoms in Individuals with Hypothyroidism at a Specialized Medical Facility.

Materials and Methods: A comprehensive assessment was conducted on 100 individuals who had been diagnosed with hypothyroidism. The evaluation involved the utilization of the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Scale (HAM-A). The study included participants of all genders, ranging in age from 18 to 45 years, who had confirmed diagnoses of hypothyroidism and provided their explicit written consent.

Results: Out of the participants, 73% were females and 27% were males. Among the total sample, 63% displayed different levels of depression based on the HDR Scale, while 65% exhibited varying degrees of anxiety according to the HAM-A scales. When considering males, the most prevalent symptoms in line with the HDR scales were feelings of depression (74.07%) and anxiety (85.18%). Conversely, among females, the most frequent symptoms were somatic symptoms related to the gastrointestinal system (69.86%). Analyzing the HAM-A scales, the primary symptom for males was depressed mood (92.59%), whereas for females, it was anxious mood (93.15%).

Conclusion: There is significant prevalence of depression and anxiety among the patients with hypothyroidism.

Association of Non High Density Lipoprotein-Cholesterol and HbA1c in Type 2 Diabetes Mellitus

Saroj Thapa, Nirish Vaidya, Rachana Pandey, Jyoti Shrestha Takanche — Sun, 31 Dec 2023 00:00:00 +0000

Background: Dyslipidemia is a common issue among diabetic patients and is associated with an increased risk of cardiovascular disease. Non-High Density Lipoprotein-cholesterol has emerged as a valuable marker for assessing combined cardiovascular risk in diabetes. Measures to improve the Non-High Density Lipoprotein-cholesterol within optimal level might improve the glycemic status and decrease the cardiovascular risk. This study aims to examine the relationship between Non-High Density Lipoprotein-cholesterol and glycated hemoglobin levels in type 2 diabetic patients.

Materials and Methods: A hospital-based comparative cross-sectional study was conducted on 544 individuals diagnosed with type 2 diabetes. The classification of lipid profile and glycemic control was carried out as per the National Cholesterol Education Program Adult Treatment Plan III and American Diabetes Association guidelines.

Results: Our study found that Non-High Density Lipoprotein-cholesterol levels was higher in uncontrolled diabetes (157.9±46.8) compared to controlled diabetes (132.6±40.6), with a statistically significant difference (P<0.001). There was a weak positive correlation between Non-High Density Lipoprotein-cholesterol and glycated hemoglobin levels (r=0.37).Among the total participants, 226 (41.5%) had optimal Non-High Density Lipoprotein-cholesterol level whereas 318 (58.5%) had high Non-High Density Lipoprotein-cholesterol.

Conclusion: This study confirms a positive correlation between Non-High Density Lipoprotein-cholesterol and HbA1c levels in type 2 diabetic patients. Dyslipidemia prevalence was substantial, emphasizing the importance of achieving target Non-High Density Lipoprotein-cholesterol levels for improved glycemic control and cardiovascular risk reduction.

Surgical Experience of Reconstruction of Distal Lower Limb Soft Tissue Defect with Reverse Sural Artery Flap with Cutaneous Pedicle

Ranjib Kumar Jha, Santosh Thapa, Asish Rajthala — Sun, 31 Dec 2023 00:00:00 +0000

Background: The soft tissue reconstruction of distal leg, ankle and foot is always challenging to orthopaedic surgeons. Among many available options, the reverse sural artery flap is technically easy local option to cover soft tissue defect. We aim to share our experience of reverse sural fasciocutaneous flaps for reconstruction of distal leg soft tissue defect.

Materials and Methods: An observational retrospective study was conducted on all cases that had undergone reverse sural flap surgery between February 2019 to January 2023 in orthopedic department of Nobel Medical College Teaching Hospital. The following variables were gathered for analysis: hospital stay duration, postoperative complications, etiology and duration of the wound, wound site and size, number of surgeries, associated trauma, surgery time and technical details, and final outcome in terms of flap survival.

Results: Out of 20 cases, sixteen were male and 4 were female. The mean age was 36 years. Seven cases (35%) had associated comorbidities. The most common etiology was trauma and most common sites was ankle and calcaneus (60%) followed by distal leg (35%) and foot (5%). The graft survival rate was 85%. Three cases (15%) had partial flap necrosis and one (5%) had venous congestion.

Conclusion: The reverse sural artery flap is easy, versatile and reliable technique to cover soft tissue defect in distal leg, ankle and foot.

Use of Dexmedetomidine as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Patients Undergoing Upper Limb Surgery

Sun, 31 Dec 2023 00:00:00 +0000

Background: Various adjuvants have been added in Brachial plexus block but only few studies have reported the use of dexmedetomidine. Alpha 2 agonist Dexmedetomidine used as an adjuvant to the local anesthetic has been suggested to prolong the duration of peripheral nerve block. The objective of this study is to compare the effect adding Dexmedetomidine to Ropivacaine in Supraclavicular brachial plexus block

Materials and Methods: A Quantitative, comparative cross sectional prospective study was conducted in 78 patients randomly allocated into three groups. Group R received 30ml of 0.5% Ropivacaine, Group B received 30ml of 0.5% Ropivacaine + 50mcg of Dexmedetomidine for supraclavicular block and Group Y received 30ml of 0.5% Ropivacaine 0.5% for supraclavicular block and intravenous Dexmedetomidine 50mcg . The onset time to sensory and motor blockade, duration of sensory and motor block and duration of analgesia were recorded.

Results: The onset of Sensory block and motor block was earlier in group B than in group Y and group R. The duration of sensory block and motor block duration was also prolonged in group B when compared with group Y and group R. The duration of analgesia was significantly longer in group B, and group Y when compared to group R.

Conclusion: Dexmedetomidine as an adjuvant to Ropivacaine decreases the sensory as well as motor block onset time, prolongs sensory and motor block duration and also increases the duration of analgesia. The action of Dexmedetomidine most probably is local rather than centrally mediated.

Self Management among Diabetes Patients

Sun, 31 Dec 2023 00:00:00 +0000

Background: In the management of diabetes mellitus, the role of self-care has been pivotal. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of disease by participating in their care.This study aimed to assess self-management among diabetes patients.

Materials and Methods: Analytical cross-sectional study was conducted among 232 patients with diabetes selected by convenience sampling. Diabetes Self Management Questionnaire-Revised was used to assess self-management among diabetes patients. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (bivariate logistic regression).

Results: Findings of the study revealed that out of 232 respondents, 48.7% had suboptimal diabetes self-management practices. The global score for diabetes self-management was 5.28± 1.34 The mean score for subscale cooperation with the diabetes team was highest i.e., 7.50± 1.94 followed by medication taking subscale (6.94±3.14), physical activity subscale (5.37± 3.09), eating behavior subscale (5.35±1.71) and glucose monitoring subscale (0.83± 2.19) respectively. The results further indicated a significant association between diabetes self-management and religion, type of diabetes medication, glycemic control, and diabetes complications at p<0.05.

Conclusion: The present study showed that almost half of the respondents had suboptimal diabetes self-management. Therefore, healthcare providers should further design and implement interventions to improve self-management behavior among diabetes patients

Influence of Social Media Use on Employees Self-Confidence among Health Service Providers in Selected Health Institutes

Sun, 31 Dec 2023 00:00:00 +0000

Background: The social media use and its impact on employee self-confidence in the workplace have garnered attention and concern. However, limited studies exist in the Nepali context. Therefore, researchers aim to examine the influence of social media use on Employee Self-Confidence and explore the moderating role of age in the relationship betweenSocial media use and employee self-confidence.

Materials and Methods: Utilizing a quantitative cross-sectional design and convenience sampling, data were collected from July to Aug, 2022, via Google Forms for selected health institutes in Kathmandu Valley. The sample size was 149. Ethical clearance was obtained from Yeti Health Science Academy, IRC, recognized by the Nepali Health Research Council. Modified 11-point items, using a 5-point Likert scale (1 to 5) for social media use and employee self-confidence, were validated through pilot tests, Cronbach's alpha, factor analysis, and content validity. The independent variables of social media use and employee self-confidence exhibited robust performance, providing valuable insights for the study.

Results: Researchers conducted descriptive, regression, and moderation analyses to examine the frequency, influence, and moderating role of age in this study. Facebook emerged as the preferred social media platform. The analysis revealed that social media use has a significantly positive influence on employee self-confidence (Beta = 0.588, p < 0.001). Age significantly moderates the relationship between social media use and employee self-confidence, with beta values indicating a negative relationship.

Conclusion: Social media use is gaining popularity, even in health institutes. Effectively utilized, it contributes significantly to the workplace, as evidenced in this study. Age also showed a moderating role, suggesting health care leadership should initiate interventions to foster social media use among employees for increased confidence, and performance.

Transabdominal Pre-Peritoneal Versus Totally Extraperitoneal Laparoscopic Techniques for Inguinal Hernia Repair in Eastern Nepal

Sun, 31 Dec 2023 00:00:00 +0000

Background: Inguinal hernia is one of the most common surgical problems in the world, with a high risk in men. The treatment modalities have evolved from open to laparoscopic procedures. Laparoscopic procedures are getting attention and widespread utilization among surgeons. The choice between the two procedures is still a debate between the surgeons. This study aims to compare the transabdominal pre-peritoneal approach to the totally extraperitoneal approach in its perioperative outcomes.

Materials and Methods: A prospective analytical study was conducted on 86 adult patients, who underwent laparoscopic inguinal hernia reduction between June 2022 to June 2023 at Nobel Medical College Teaching Hospital in Biratnagar, Nepal. The patients were randomized into two groups of 43 participants each and were analyzed on different variables.

Results: All of the 86 patients included in the study were male. Among them, 30.23% of patients had direct inguinal hernia. There were 12.79% of patients with bilateral hernias. There was a statistically significant difference in the duration of operation among the patients undergoing totally extraperitoneal and transabdominal preperitoneal hernia repair. Total duration of hospital stay was shorter in totally extraperitonealand postoperative pain was slightly lesser in totally extraperitoneal procedure. The intraoperative and postoperative complications among totally extraperitoneal and transabdominal preperitoneal hernia repair were comparable. There was no conversion to open procedure or recurrence of hernia during the study period. The return to daily life took longer in the transabdominal preperitoneal procedure than in the totally extraperitoneal hernia repair.

Conclusion: Totally extraperitoneal hernia repairhas an advantage over transabdominal preperitoneal hernia repairin terms of shorter operative time, postoperative pain, duration of hospital stays, and return to daily life.

Outcome of Early Excision versus Delayed Excision and Grafting in Burn Less than Twenty Percent Body Surface Area

Kamal Raj Pathak, Surendra Jung Basnet, Shankar Man Rai — Sun, 31 Dec 2023 00:00:00 +0000

Background: Burn injuries are a significant public health concern associated with high morbidity and mortality. Surgical interventions, including early excision and grafting or delayed excision and grafting are crucial for deep burns. This study compares graft take, number of procedures, duration of stay, and burn wound infections between early excision and grafting and delayed excision and grafting groups.

Materials and Methods: A comparative study was conducted at a burn referral center from January 1st to March 31st, 2020. Eighty-six patients (43 in each group) with deep burns covering 10-20% TBSA were included. Early excision and grafting and delayed excision and grafting groups were determined by the timing of the first operation (within or beyond 7 days post-injury). Parameters compared included graft take, number of grafting procedures, duration of stay, and graft site infection.

Results: Both groups had a mean age of 42.6 years, with predominantly female populations. The mean total body surface area % of burn area was 15%. Early excision and grafting and delayed excision and grafting groups showed comparable outcomes in graft take (90.6% vs. 88.16%), mean duration of hospital stay (16.72 vs. 16.53 days), number of surgical procedures (1.3 vs. 1.4), and graft site infection (23.3% vs. 30.2%).

Conclusion
Graft take, duration of hospital stay, number of surgical procedures, and graft site infections were comparable in Early excision and grafting and delayed excision and grafting groups for burns covering less than twenty percent body surface area. Delay in excision and grafting did not significantly impact outcomes in smaller burns, providing valuable insights for managing delayed burn presentations.

Impact of Tailored Intensive Rehabilitation on Functional Independence and Quality of Life in Brain Tumor Patients: A Prospective Observational Study

Sun, 31 Dec 2023 00:00:00 +0000

Background: Brain tumors are a heterogeneous group causing disability. They significantly impact functional independence and quality of life. This study aims to investigate how tailored intensive rehabilitation affects brain tumor patients using the functional independency measure score.

Materials and Methods: This is a prospective observational correctional study conducted in the department of Neurophysiotherapy and Neurosurgery at Nobel Medical College Teaching Hospital, Biratnagar over a period of 18 months. A total of 96 brain tumor patients who underwent surgery at a tertiary care centerduring the study period were included. Along with the demographic data, the diagnosis ofbrain tumor functional independency was assessed using the Functional Independence Measure Index.

Results: A total of 96 brain tumor patients (44 males, 52 females, average age 55.6 years) were studied. The tumors' distribution showed variations, with glial tumors being the most frequent (36.4%). The Functional Independence Measure (FIM) Index was used to assess functional independence, yielding an average score of 82.5. Patients with meningioma had higher FIM scores (84.3) compared to glial cell tumor patients (80.1), although not statistically significant (p = 0.122).The study also explored correlations between FIM scores, hospital stay duration (average 9 days), and patient satisfaction. A weak positive correlation (r = 0.25) existed between FIM scores and hospital stay duration.A moderate positive correlation (r = 0.65) was found between FIM scores and patient satisfaction, suggesting higher satisfaction among patients with better functional independence.

Conclusion: Intensive rehabilitation therapy shows promise in improving functional independence in brain tumor patients.

Scrub Typhus Associated Secondary Hemophagocytic Lymphohistiocytosis in Pediatric Intensive Care Unit

Sun, 31 Dec 2023 00:00:00 +0000

Background: Scrub Typhus is febrile illness caused by orientia tsutsugamusi and presents with multiorgan involvement. It can cause multiorgan failure resulting in acute respiratory distress syndrome, acute kidney Injury and hemophagocytic lymphohistiocytosis. Secondary hemophagocytic lymphohistiocytosis is rare but life threatening clinical condition caused by uncontrolled activation of inflammatory cytokines and accumulation of activated macrophages and lymphocytes.

Materials and Methods: This study is a prospective observational study conducted on children with Scrub Typhus being admitted to Pediatric Intensive care Unit of Nobel Medical College during 12 months period from July 2022 to June 2023. Basic demographic features, clinical presentation, severity and outcome were analyzed. Categorical variables were reported as frequencies, and continuous as mean ± SD. Independent sample t-test and chi square test was used for comparison of means and categorical variables.

Results: A total of 32 children with scrub typhus were included. Common age group was >10 years. Fever, hepatosplenomegaly, rash and respiratory distress were common clinical features. Among 32 cases, 7 (21.87%) had Encephalitis, 10 (31.25%) developed acute respiratory distress syndrome, 13 (40.62%) had Shock, and 9 (28.12%) developed secondary hemophagocytic lymphohistiocytosis. Among 9 children with scrub typhus associated secondary hemophagocytic lymphohistiocytosis, all of them had Hyperferritenemia, Hypofibrinogenemia, and Hypertriglyceridemia. Hemophagocytosis was identified in (55.55%) in bone marrow biopsies. 1 patient succumbed to multiorgan failure.

Conclusion: Secondary hemophagocytic lymphohistiocytosis should be considered in children with Scrub typhus requiring Intensive care support. Early recognition and prompt treatment can result in good outcome in children with Scrub typhus associated secondary hemophagocytic lymphohistiocytosis.

Prevalence of Thyroid Disorders among Pregnant Women at Birat Medical College Teaching Hospital

Sun, 31 Dec 2023 00:00:00 +0000

Background: Thyroid disorders (TD) are the second most common endocrine disorders seen in pregnancy. TD is known to be associated with adverse maternal and fetal outcomes.

Materials and Methods: This was a hospital based descriptive cross-sectional study. All the pregnant women attending the antenatal clinic at Birat Medical College Teaching Hospital from 1^st July 2021 to 30^th June 2022 were enrolled in the study, irrespective of their gestational age and gravida status. Pregnant women with diagnosed thyroid disorder and are on medication, multiple gestation, Diabetes mellitus, Hypertension and pregnant women with age more than 35 years were excluded from study. Thyroid function status of pregnant women was assessed by measuring serum levels of thyroid stimulating hormone (TSH) and if the TSH value was deranged then they underwent free T3 and free T4 level. Based on the TFT reports they will be classified as euthyroid, subclinical hypothyroidism and overt hypothyroidism, subclinical hyperthyroidism and overt hyperthyroidism.

Results: A total of 395 pregnant women were enrolled in this study. The mean age and standard deviation of pregnant women was 25.25± 4.76 years. Among 395 pregnant women 93(23.6%) pregnant women have thyroid disorder. Subclinical hypothyroidism and Overt hypothyroidism were 19% and 1.8% respectively. Subclinical and Overt hyperthyroidism were 1.5% and 1.3% respectively.

Conclusion: The prevalence of thyroid disorder in pregnancy was 23.6%. The most common thyroid disorder observed was Subclinical hypothyroidism comprising 19% cases followed by overt hypothyroidism comprising 1.8% cases followed by Subclinical and Overt hyperthyroidism 1.5% and 1.3% cases respectively.

Pelvic Floor Dysfunction and Quality of Life among Hysterectomy Cases at B.P. Koirala Institute of Health Sciences

Sun, 31 Dec 2023 00:00:00 +0000

Background: Pelvic floor dysfunction a global major female reproductive health burden associated with genitourinary and psychosocial symptoms even after hysterectomy has been underreported in the developing world. The study aimed to determine the early incidence of pelvic floor dysfunction and its psychological impact among post-hysterectomy women.

Materials and Methods: It was a prospective cohort study for 52 weeks among 130 post-hysterectomy cases at the tertiary care center. Pelvic floor dysfunction was diagnosed with the Pelvic Floor Disability Index and quality of life with the Pelvic Floor Impact Questionnaire. The association of pelvic floor dysfunction with epidemiological characters was analyzed using SPSS version 20.

Results: The incidence of pelvic floor dysfunction was 7.8% and the impact on the quality of life was 2.7% among 130 post-hysterectomy cases. Age, body mass index, comorbidities like chronic obstructive lung disease, and previous abdominal surgery were statistically significant. A parity of three or more, caesarian sections with instrumental delivery and Transabdominal hysterectomy was statistically significant with pelvic floor dysfunction and Socio-Psychological effect within the same groups of patients. The most common symptoms were urinary symptoms accounting for 9(90%) followed by prolapse 5 (50%) and colorectal 4(40%) with a score of 20.82± 9.07, 7.48±4.5 and 6.97± 1.55, and quality of life was mostly impacted by bladder symptoms 3 (100%) with a score of 24.96±2.96.

Conclusion: Pelvic floor dysfunction is a common health burden among post-hysterectomy cases especially with older age, higher Body Mass Index, Chronic Obstructive Pulmonary Disease, parity of more than three and caesarian sections with instrumental delivery.

Depression, Anxiety and Stress among Nursing Students at Biratnagar

Sita Chapagain, Saraswata Neupane, Indira Pokhrel, Tara Kumari Kafle — Sun, 31 Dec 2023 00:00:00 +0000

Background: Nursing students’ depression, anxiety and stress are important issue in society with strongest connection to client recover when these students become nurse in future.Such psychological distress among them leads to less productivity, reduced quality of life, learning difficulties and may negatively affect patient care.

Materials and Methods: A descriptive, cross-sectional study was conducted in Nobel Medical College Teaching Hospital, Biratnagar. A total of 104 Bachelor nursing students were selected by using a non-probability total enumerative sampling technique. Data were collected in the classroom through self-administered questionnaire using standardized tool DASS-21. All calculations and statistical analyzed by using SPSS software version 23.0.

Results: The mental health status of nursing students reported alarming accounting about 37% severe anxiety, 17% severe depression and severe stress each. Among the six variables run, only year of study found associated with depression, however, stress and anxiety were not found associated with all given six variables. Similarly, there is very strong positive correlation was found among stress, anxiety and depression.

Conclusion: The number of students experiencing depression, anxiety and stress were some levels. Among the six variables run, only year of study found associated with depression but none of the variables found associated with other mental health dimensions. Similarly, the dimension of mental health: stress, anxiety and depression were found strongly correlated.

Computed Tomography Assessment of Linear Splenic Dimensions and their Correlation with Anthropometric Measurements in Nepalese Population

Crystal KC, Bikash Bikram Adhikari, Rakshya Parajuli — Sun, 31 Dec 2023 00:00:00 +0000

Background: Geographical locations and ethnicity may influence variations in normal spleen dimensions, potentially leading to errors in assessment. This study aimed to correlate splenic dimensions with anthropometry and predict their variation with age and body surface area.

Materials and Methods: Subjects (n=384) undergoing abdominal computed tomography were selected by random sampling. Splenic volume was calculated using the standard prolate ellipsoid equation. Correlation of splenic volume with body surface area and body mass index was done with Pearson’s correlation analysis. A multiple regression was run to predict splenic volume from age, height, and body surface area.

Results: The mean age was 45±18 (range, 18-90 years). The mean splenic length, width, thickness, and volume were 7.6 ± 1.7 cm, 8.8 ± 1.5cm, 3.8 ± 0.9 cm, and 139 ± 58.2 cm³, respectively. The splenic width and splenic volume were significantly lower at extremes of age. A significant (P<0.05) correlation was seen between splenic volume, body surface area(r=0.393) and body mass index (r=0.126); a negative correlation was observed between splenic volume and age (r=-0.180). Splenic dimensions were significantly larger in males. Multiple regression revealed that an increase in body surface area (by 10 cm²), predicted increased splenic volume was 4.3 cm³. An increase in age (by 1-year), predicted decrease in splenic volume was 8.3 cm³. For 10 cm increase in height, predicted increase in splenic volume was 1.7cm³.

Conclusion: The study showed a positive correlation between splenic volume and body surface area, as well as body mass index and provides a crucial normative data for assessing splenic enlargement in Nepalese population.

Serum Procalcitonin as a Biomarker for Diagnosing Neonatal Sepsis in a Tertiary Care Hospital of Eastern Nepal

Arun Giri, Sunil Kumar Yadav, Vijay Kumar Sah, Amaresh Kumar Kushwaha — Sun, 31 Dec 2023 00:00:00 +0000

Background: Sepsis is the main cause of morbidity and mortality in neonates. Early diagnosis and appropriate treatment can reduce the mortality rate. Blood culture is the gold standard for diagnosis of bacterial sepsis, but it requires 3-5 days for results. Since the disease may progress rapidly in neonates, a faster diagnostic test is needed. This study aimed to investigate and evaluate the role of serum procalcitonin as a marker for diagnosis of neonatal sepsis, aiming to enhance early detection and improve clinical outcomes.

Materials and Methods: This was a hospital-based cross-sectional observational study carried out in 350 neonates admitted with suspicion of neonatal sepsis in Neonatal Intensive Care Unit (NICU) of Nobel Medical College Teaching Hospital (NMCTH), Biratnagar, Nepal during 1 year between October 2021 to September 2022.

Results: The study included 350 cases, with a median age of 4days (1day to 4 days). Males made up the majority of cases (69.71%), as did Hindus (70.29%). Similarly, 78.86% of the cases had serum procalcitonin levels more than or equivalent to 0.5 ng/ml. Possible sepsis (43.43%) accounted for the majority of cases. The cases age, gender, and religion were shown to have a statistically significant relationship with serum procalcitonin.

Conclusion: Therefore, we draw the conclusion that serum procalcitonin may not be the only diagnostic marker to diagnose neonatal sepsis in term/near term newborns, but it may be helpful when paired with other test indicators.

Effect on Onset and Duration of Sensory and Motor Block with Single Bolus Dose of Intravenous Dexmedetomidine as an Adjuvant on Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Limb Surgery

Rupak Bhattarai, Parasmani Shah, Prabin Sharma — Sun, 31 Dec 2023 00:00:00 +0000

Background: The hyperbaric bupivacaine is being widely used for spinal anesthesia in lower limb surgeries. Dexmedetomidine can be used intravenously as well as an intrathecal injection along with spinal anesthesia for surgery below the umbilicus.

Materials and Methods: This was a prospective, randomized double blinded study, where 100 patients posted for elective lower limb surgery under spinal anesthesia were divided into two groups. Group A received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous infusion of 0.5 μg /kg/hour of dexmedetomidine over a period of ten minutes. Group B received 0.5% hyperbaric bupivacaine as spinal anesthesia along with intravenous normal saline over a period of ten minutes.

Results: The onset of sensory block was 3.19 ± 0.31 minutes in group A whereas 4.5 ± 0.22 minutes in group B. The onset of motor block was 4.28 ± 1.02 minutes in group A whereas 7.12 ± 0.87 in group B. The onset and duration of sensory and motor block were statistically significant. Regarding duration of sensory block, group A had 186.5 ± 14.04 minutes whereas group B had 148.2 ± 11.31 minutes with p value <0.001. The duration of motor block was 142 ± 11.42 minutes in group A whereas 122.4 ± 8.28 minutes in group B with p value <0.001. The duration of postoperative analgesia was prolonged in group A when compared with group B.

Conclusion: Dexmedetomidine used as a single intravenous injection along with spinal anesthesia with 0.5% bupivacaine tends to shortens the onset of both sensory and motor blocks and increases the duration of sensory and motor blocks. It also prolongs the duration of analgesia with minimal or no changes in hemodynamic parameters.

Posterior Reversible Encephalopathy Syndrome Associated with Late onset Eclampsia: A Case Report

Sun, 31 Dec 2023 00:00:00 +0000

We describe a case of 25 year old women who had full term pregnancy, presented with symptoms of headache, loss of vision and seizure episodes after 7^th postpartum day. There were no findings of pre-eclampsia in antenatal stage. The diagnosis of posterior reversible encephalopathy syndrome was made after magnetic resonance imaging. Imaging findings include vasogenic edema of bilateral occipital lobe and parietal lobe. Hypertension and endothelial injury seems to be involved in pathophysiology of the syndrome. After appropriate management, the syndrome resolved. Early diagnosis and proper treatment plays a key role in management of posterior reversible encephalopathy syndrome.

Perforated Subhepatic Appendix Presenting as a Gas under Diaphragm: Clinical Diagnostic Challenges for Surgical Residents: A Case Report

Sun, 31 Dec 2023 00:00:00 +0000

This study addresses the rarity of the subhepatic location of the appendix, found in only 0.08% of cases, and the infrequent occurrence of perforated appendicitis presenting with gas under the diaphragm. When these two uncommon conditions coincide in the context of one of the common causes of acute abdomen, namely acute appendicitis, it poses a diagnostic challenge for surgical residents in training. The case presented involves a patient with generalized abdominal pain, soft abdomen, and tenderness over all quadrants, particularly the right upper quadrant. Her chest x-ray findings indicated free gas under the right hemi-dome of the diaphragm and an inconclusive ultrasound for acute appendicitis, computed tomography confirmed the subhepatic appendix and pneumoperitoneum. Operative intervention revealed a perforated subhepatic appendix, and the patient recovered well, being discharged on the 4th postoperative day. The clinical discussion emphasizes the ability of surgical residents to safely perform appendectomies but highlights the crucial role of experienced surgeons in managing cases with atypical presentations. The conclusion underscores the diagnostic challenges posed by atypical presentations of acute appendicitis in a clinical setting.