Nepal Journal of Medical Sciences https://nepjol.info/index.php/NJMS <p>Official Journal of Manipal College of Medical Sciences. Full text articles available.</p> Manipal College of Medical Sciences (MCOMS) en-US Nepal Journal of Medical Sciences 2091-1424 <p>Copyright © by Nepal Journal of Medical Sciences. The ideas and opinions expressed by authors of articles summarized, quoted, or published in full text in this Journal represents only opinions of authors and do not necessarily reflect the official policy of Nepal Journal of Medical Sciences or the institute with which the author(s) is (are) affiliated, unless so specified.</p> Retrospective Evaluation of Patients Leaving Against Medical Advice from Intensive Care Unit (ICU) in Tertiary Care Teaching Hospital https://nepjol.info/index.php/NJMS/article/view/36724 <p><strong>Introduction:</strong> Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treating physician whether to continue the treatment or to de-escalate from the treatment. It can deteriorate the primary disease of the patient, leading to an increase rate of re-admission to the hospital, increased morbidity and mortality. This is a worldwide phenomenon and the prevalence of LAMA varies between various countries and between different region, religion, and the socioeconomic status of the patient in the same country.<br><strong>Methods:</strong> The hospital records from 1st December 2018 to 30th November 2019 of a tertiary care teaching hospital were studied. Patient demography, disease characteristics and length of ICU stay and the factors leading to LAMA were noted and statistically analysed.<br><strong>Results:</strong> During the study period, 14.5% of patients asked for LAMA. The mean age was 51.22 ± 22.39 years (range 8 months to 97 years) with Male predominance (n= 288, 62.60%) over Female (n= 172, 37.39%). Patients residing in rural areas were 56.08% (n=258) and 63.91% were financially dependent on others for their living. The mean length of stay in hospital was 3.02 ± 3.50 days while 30.86% of patients required mechanical ventilation. About 51.73% of patients taking LAMA were admitted from the Internal medicine department. Around 79.56% were Hindus, with 54.34% opting for LAMA due to financial restrain followed by poor prognosis (22.60 %).<br><strong>Conclusion:</strong> The large number of patients admitted in ICU opts out for LAMA. This necessitates formulation and implementation of strategies to reduce the prevalence of LAMA discharge so that patient gets the optimum level of care and the burden in the health care system is reduced</p> Kiran Adhikari Kriti Devkota Rajesh Kumar Yadav Rakesh Sah Copyright (c) 2021 Nepal Journal of Medical Sciences 2021-04-30 2021-04-30 6 1 2 7 10.3126/njms.v6i1.36724 Effect of Cholecystectomy on Serum Lipids and Blood Glucose (Hospital Based Observational Prospective Study) https://nepjol.info/index.php/NJMS/article/view/36725 <p><strong>Introduction:</strong> Association between cholelithiasis and dyslipidemia has been shown in many studies. Recent studies have shown improvement in lipid profile following cholecystectomy. This study aimed to determine the changes in lipid profile and blood glucose level after cholecystectomy.<br><strong>Methods:</strong> Seventy-three patients of cholelithiasis were studied prospectively. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), atherogenic index (AI) and fasting blood sugar (FBS) levels were estimated pre-operatively. Further, the same parameters were studied after cholecystectomy after one week and one-month intervals. None of the patients received any lipid-lowering drug or dietary restriction. Results were analysed and compared.<br><strong>Results:</strong> Of the 73 patients with cholelithiasis, 66% were female and 34% male. The mean age of patients was 40.53± 13.16 years. 56% of patients with cholelithiasis had a deranged lipid profile. TC was significantly decreased at one week (p=0.002) and one month (p=0.00) interval after cholecystectomy while TG levels also decreased significantly at one month postoperative (p=0.001). There were no significant differences in LDL-c however improvement was seen on HDL-c. Blood glucose level also increased significantly (p=0.028) after one month of cholecystectomy.<br><strong>Conclusion:</strong> Cholelithiasis is associated with an abnormal lipid profile. Cholecystectomy leads to a significant decrease in some of the parameters of lipid profile and the atherogenic index. The presence of gall stones thus should be perceived in the context of metabolic syndrome, which may be investigated and treated.</p> Om Karki Bishow Deep Timilsina Copyright (c) 2021 Nepal Journal of Medical Sciences 2021-04-30 2021-04-30 6 1 8 13 10.3126/njms.v6i1.36725 ATE Scale to Assess Attitudes towards Euthanasia among Health Professionals in Pokhara, Nepal https://nepjol.info/index.php/NJMS/article/view/36726 <p><strong>Introduction:</strong> Most people want to live up to old age with no pain and sufferings. This study is meant to know the opinion of doctors and nursing professionals regarding euthanasia which is an important component for practising euthanasia in Nepal, which is a debated topic in the whole world and Nepal is no exception.<br><strong>Methods:</strong> A descriptive study design was used to conduct this study. ATE scale was used which includes ten questionnaires.<br><strong>Results:</strong> The ATE scale used in this study showed to have internal consistency, with Cronbach alpha at 0.736. Men were found to be more supportive of Euthanasia.<br>Conclusion: Overall, this study suggests that health professionals from Pokhara have a positive attitude towards Euthanasia with patients request taken as more important.</p> Sudhir Raman Parajuli Rabin Gautam Sidarth Timsinha Anil Subedi Suman Pokhrel Copyright (c) 2021 Nepal Journal of Medical Sciences 2021-04-30 2021-04-30 6 1 14 19 10.3126/njms.v6i1.36726 Advanced Maternal Age and Pregnancy Outcome at Manipal Teaching Hospital: Cross-sectional Analytical study https://nepjol.info/index.php/NJMS/article/view/36728 <p><strong>Introduction:</strong> Advanced and very advanced maternal age are associated with several adverse maternal and fetal outcome. The objective of this study was to find out the possible association between advance maternal age and adverse pregnancy outcomes at Manipal Teaching Hospital.<br><strong>Methods:</strong> A cross sectional analytical study conducted at department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. A total of 198 patient who were ≥30 years and &gt;24 weeks pregnant admitted in obstetric ward were selected. These patient were divided into three groups according to their age (30-34, 35-39 and ≥ 40years). We compared the incidence of adverse maternal and perinatal outcome among these groups. We also calculated odds ratio of maternal and perinatal outcomes in 35-39 years and ≥ 40years women, compared with women aged 30-34 years.<br><strong>Results:</strong> Comparison of the three age groups revealed that advanced maternal age constitute a predisposing factor for malpresentation, gestational diabetes mellitus, placenta previa, fetal distress and caesarean section. Whereas, risk of non progress of labour, preterm birth, postpartum hemorrhage, perinatal death and congenital anomalies were increased in very advanced maternal age group. From these, statistical significance was reached in case of greater risk of malpresentation (p=0.01,OR=6.66), fetal distress (p=0.04, OR=2.6) and caesarean section(p=0.02,OR=2.06) in advanced age group when compared to the patients aged 30-34. Furthermore, very advanced age group were higher risk of postpartum hemorrhage (p=0.03, OR=2.47) and congenital anomalies, which were statistically significant (p=0.04, OR=29.57) when compared to the 30-34 years.<br><strong>Conclusion:</strong> Advanced and very advanced maternal age is associated with several adverse maternal and perinatal outcome. The risk of perinatal complication begin to increase after the age of 35 but significantly increased after 40 years.</p> Vibha Mahato Pravin Shrestha Pradeep Bhattarai Copyright (c) 2021 Nepal Journal of Medical Sciences 2021-04-28 2021-04-28 6 1 20 25 10.3126/njms.v6i1.36728 Comparative Study of Efficacy and Safety of Diacerein versus Acelofenac in Patient with Knee Osteoarthritis https://nepjol.info/index.php/NJMS/article/view/36729 <p><strong>Introduction:</strong> There are different pharmacological modalities currently in practice for the treatment of osteoarthritis knee. Broadly these are divided into anti-inflammatory drugs such as NSAIDs and symptomatic slow-acting drugs in osteoarthritis (SYSADOA). Diacerein, an anthraquinone derivative inhibits IL-1b and has been shown to significantly decrease the symptoms.<br><strong>Methods:</strong> This is open label, prospective comparative study. Total 40 patients were divided into two groups: group A (diacerein) and group B (aceclofenac) by alternate method. In group A diacerein was given 50mg orally for 1 week followed by 50 mg orally twice a day for 3 weeks. In group B aceclofenac 200 mg sustained release tablet was given orally once a day for 4 weeks. Outcomes were measured at the end of the treatment period i.e. at four weeks and after two weeks of discontinuation of treatment i.e. at 6 weeks.<br><strong>Results:</strong> Improvement is observed in both treatment groups in their baseline value in terms of efficacy parameters. Results of VAS and WOMAC scores were better in group B (aceclofenac). However intra-group analysis showed VAS scores and WOMAC scores significantly decreased in patients receiving diacerein as well. (p&lt;0.05).<br><strong>Conclusion:</strong> Though not superior to the control drug, diacerein showed efficacy in terms of measurement by patient self-reported WOMAC and VAS scores for the treatment of Osteoarthritis knee.</p> Sashmit Sharma Kiran Prasad Rijal Tanup Prasai Himal Khanal Copyright (c) 2021 Nepal Journal of Medical Sciences 2021-04-30 2021-04-30 6 1 26 33 10.3126/njms.v6i1.36729 Online Healthcare Service Delivery in Nepal during COVID Era: A challenge https://nepjol.info/index.php/NJMS/article/view/36802 <p>N/A</p> Prakash Sharma Copyright (c) 2021 Nepal Journal of Medical Sciences 2021-04-30 2021-04-30 6 1 1 1 10.3126/njms.v6i1.36802