Journal of Chitwan Medical College 2022-03-15T00:10:10+00:00 Rajib Chaulagain Open Journal Systems <p>Journal of Chitwan Medical College (JCMC) is an open access, peer reviewed, quarterly, multidisciplinary biomedical journal devoted to Health Sciences. JCMC is official journal of the Chitwan Medical College (CMC), Bharatpur, Nepal, published since 2010. It is meant to provide academic platform for all the medicos and also to ensure their scientific involvement in different areas medicine by promoting sharing their newer development.</p> <p>The JCMC [ISSN 2091-2412(Print), 2091-2889(Online)], welcomes scientific research articles, unique cases and reviews of general interest to medical researchers or medical educationists from the field of biomedical sciences.</p> <p>It publishes articles on the following category: Original Article, Review Article, Case Report/ Series, images in clinical sciences, Editorials, Viewpoint, Book Reviews, Medical Education, Book Reviews, Specially Invited Articles and Letter to the Editor.</p> Knowledge, attitude and practice related to diabetes mellitus in dentists of Nepal 2022-03-14T09:38:45+00:00 Bishal Joshi Buddhi Raj Pokhrel Laxmi Shrestha Sanjit Kumar Kar Narayan Bahadur Mahotra <p><strong>Background</strong>: Diabetes mellitus (DM) is one of the most common systemic diseases encountered by dentists in daily practice. The present study aimed to assess the knowledge, attitude, and practice of dentists regarding diabetes mellitus.</p> <p><strong>Methods: </strong>This cross-sectional study was conducted among the dentists of Nepal from August to December 2020. A total of 345 dentists throughout the country took part in this study. A set of 27 self-designed questions was used as the study tool, among which 11 questions were about knowledge, seven were about attitude, and nine were about practice related to DM. The result was expressed in frequency and percentage. Chi square and Spearman’s correlation analysis were performed with SPSS version 16.</p> <p><strong>Results: </strong>The mean knowledge score was 8.15 ± 1.54 with 11 being the highest possible score. Of the total participants, 252 (73%) had good knowledge regarding DM. The mean attitude score was 4.68 ±1.19, where seven was the highest possible score. Of the total respondents, only 190 (55.1%) had a positive attitude. The mean practice score was 7.19 ± 1.19, with nine being the highest possible score. A majority of the respondents (N = 320, 92.8%) had good practice habits regarding diabetic patients. Correlation analysis showed a weak positive but significant correlation among knowledge, attitude, and practice.</p> <p><strong>Conclusions: </strong>There was good knowledge and practice in dentists though there were frequent areas of improvement in attitude. Various trainings like continuing medical educations (CME) may be beneficial to improve personal beliefs.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Bishal Joshi, Buddhi Raj Pokhrel, Laxmi Shrestha, Sanjit Kumar Kar, Narayan Bahadur Mahotra Acute glomerulonephritis in children: a hospital-based study in a tertiary care centre in Nepal 2022-03-14T17:15:18+00:00 Sudhir Adhikari Deekshanta Sitaula Shanti Regmi Biraj Parajuli Sumita Poudel <p><strong>Background</strong>: Acute glomerulonephritis is a common pediatric kidney disease which places a huge burden in developing countries. This study aimed to evaluate causes, clinical manifestations, laboratory findings and complications of acute glomerulonephritis in children presented to a tertiary care center of Nepal.</p> <p><strong>Methods:</strong> This was a retrospective review of records of children admitted with acute glomerulonephritis at Chitwan Medical College from April 2018 to February 2021. Socio-demographic data, clinic-laboratory profile and outcomes were obtained from medical records and descriptive analysis was carried out.</p> <p><strong>Results:</strong> Among 48 recruited children with acute glomerulonephritis, 60.4% were male and the mean age was 9.5 ± 3.7 years. Post infectious glomerulonephritis including post streptococcal glomerulonephritis (48%) was the main cause of acute glomerulonephritis. The major clinical features were edema (81.3%), hypertension (72.9%), dyspnea (29.2%) and hematuria (25%). ASO titer was positive in 45.8%. The complications noted were acute kidney injury (6.3%), hypertensive emergency (6.3%) and congestive cardiac failure (2.1%).</p> <p><strong>Conclusions:</strong> Most of the patients were above 5 years of age and presented most commonly during autumn and summer season.&nbsp; The complications of acute glomerulonephritis were acute kidney injury, hypertensive emergency and congestive cardiac failure.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Sudhir Adhikari, Deekshanta Sitaula, Shanti Regmi, Biraj Parajuli, Sumita Poudel Sealing ability of different bioceramic materials used to repair furcal perforation: an in-vitro spectrophotometer analysis 2022-03-14T17:15:19+00:00 Kriti Shrestha Snigdha Shubham Vanita Gautam Rupam Tripathi Chetna Arora Sageer Ahmed <p><strong>Background</strong>: The choice of sealing material is a crucial factor that influences the outcome of endodontic treatment. Several materials such as IRM, composite, RMGIC were the most commonly used perforation repair materials. However, none of these materials were able to re-establish the normal architecture predictably in perforated furcations. Contemporary Bioceramic materials have been presumed to have promising result. The aim of this study was to compare sealing ability of different Bioceramic materials used to repair furcal perforation.</p> <p><strong>Methods:</strong> Sample size of 60 extracted maxillary and mandibular molars were taken. Access opening done and furcal perforation made with #4 carbide bur. The teeth were divided into two control groups i) Negative control with no furcal perforation and ii) Positive control where furcal perforation was sealed with GIC and four experimental groups where furcal perforation were repaired with i) ProRoot MTA, ii) MTA Angelus, iii) MTA plus and iv) Biodentine respectively, each group containing 10 teeth. Microleakage was evaluated by GLM using UV Spectrophotometer for duration of 20 days.</p> <p><strong>Results:</strong> The least microleakage was observed in Biodentine followed by MTA Plus, MTA Angelus and ProRoot MTA till 11th day whereas on 15th and 20th day the least microleakage was observed in MTA Plus followed by Biodentine, MTA Angelus and ProRoot MTA.</p> <p><strong>Conclusions:</strong> There is no significant difference between mean microleakage of MTA Plus and Biodentine emphasizing the fact that both materials are comparable in terms of its sealing ability.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Kriti Shrestha, Snigdha Shubham, Vanita Gautam, Rupam Tripathi, Chetna Arora, Sageer Ahmed Morphology of condyle- a radiographic study 2022-03-14T17:15:20+00:00 Pranay Ratna Shakya Rinky Nyachhyon Amita Pradhan Ratina Tamrakar Sudeep Acharya <p><strong>Background</strong>: Mandibular condyle has a variety of morphology. The changes in their shape and size has been attributed to ageing process, developmental abnormalities, distinct diseases, trauma, endocrine shock, radio therapy etc. Panoramic radiographs remain the easiest, safest and most cost-effective screening modality for temporomandibular joint abnormalities. The study aimed to assess the different shapes of condyles using orthopantomograms from the archives of the hospital data. The variations among the sexes and between the right and left sides of an individual were also determined.</p> <p><strong>Methods:</strong> This retrospective study was conducted at People’s Dental College and Hospital within the time period of 1 year (November 2019- November 2020). Orthopantomogram of patients falling within the inclusion criteria were studied.&nbsp; The different shapes of condylar process were traced using marker pencil for both right and left sides. Data collected was entered in Microsoft Office Excel sheet 2013-- and calculated in SPSS version 24 and analyzed using descriptive statistics.</p> <p><strong>Results:</strong> Out of the 874 mandibular condyles of 437 patients, the most common was the oval shaped in both the right (275) and the left sides (277), followed by bird beak, diamond, flat and crooked finger respectively. The oval shaped condyle appeared to be predominant in both sexes. The flat shaped and diamond shaped condyle appeared to be a rarity.</p> <p><strong>Conclusions:</strong> The most common shape of condyle was found to be oval shape bilaterally and in both genders.&nbsp; Least observed shapes of condyle were flat shape in female patients and diamond shape in male patients.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Pranay Ratna Shakya, Rinky Nyachhyon, Amita Pradhan, Ratina Tamrakar, Sudeep Acharya Perspective of dental professionals towards use of cast partial denture in Nepal 2022-03-14T09:38:52+00:00 Srijana Mishra Sapkota Smriti Narayan Thakur Bibek Khanal <p><strong>Background</strong>: With increase in treatment options for rehabilitation of partially edentulous patients, the use of cast partial denture in clinical practice as well as teaching curriculum has been decreased. The objective of this study was to evaluate the perspective of dental professionals towards use of cast partial denture in Nepal.</p> <p><strong>Methods: </strong>The study consisted of nine close-ended questions regarding the use of cast partial denture by dental professionals in clinical practice throughout Nepal. The weblink of the questionnaire were shared via E-mail to dentists practicing in Nepal, to obtain a response of 350. Statistical analysis was done using SPSS version 26.</p> <p><strong>Results: </strong>The study showed that the most preferred choice of rehabilitation was fixed partial denture by all dental professionals around 52.6% of , 60% of prosthodontists and 48.9% by other specialist dentists.The least preferred choice was Removable partial denture about 16.6% by general dental practitioners, 18.5% by prosthodontists and 13.3% by other specialist dentists.Among the different types of removable partial dentures, acrylic partial denture was the most preferred one and the primary reason for not recommending cast partial dentures by the dental professionals was too complicated procedure to be carried out. Nevertheless, majority of the dentists were in favor of giving more importance for teaching cast partial dentures in graduation curriculum.</p> <p><strong>Conclusions: </strong>The study concluded that the use of cast partial denture is declining in clinical practice in Nepal due to the complicated procedure of fabrication and esthetic concern. Therefore, there is a need to emphasize the significance of teaching of cast partial dentures in graduation curriculum.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Srijana Mishra Sapkota, Smriti Narayan Thakur, Bibek Khanal Practice regarding dry eye syndrome among general population in central region of Nepal 2022-03-14T09:43:05+00:00 Polina Dahal Pradeep Bastola <p><strong>Background</strong>: Dry eye disease is a common disorder of the tear film due to decreased tear production, excessive tear evaporation, or abnormality in mucin or lipid components of the tear film associated with symptoms of ocular discomfort. Dry eye disease is a chronic, multifactorial disease, which is also called keratoconjunctivitis sicca. The aim of this study is to know about the practice concerning Dry Eye Disease and analyze the associated risk factors in Central Region of Nepal.</p> <p><strong>Methods:</strong> This was a cross-section hospital-based, observational study conducted in Chitwan Medical College and Teaching Hospital from 17 September 2021 to 16 December 2021.Cases enrolled over 3 months were administered in ocular surface disease. Proforma was designed and filled to evaluate the practice and risk factors of DED. SPSS version 26 was used to analyze the data entered in a specified proforma.</p> <p><strong>Results:</strong> During the pandemic period 300 patient participated in the study. Among the patient rolled in the study 217 (72.33%) had&lt;10sec of TBUT and 83(27.67%) had&gt; 10sec TBUT. 47(15.67%), normal Schirmer’s test, 148(49.33%) had mild and 78(26%) moderate, 27(9%) had severe dry eye. Most of the patient presented with dryness 119(39.8%), Foreign body sensation 97(32.3%), itching 52(17.3%) and Redness 22(7.3%).</p> <p><strong>Conclusions:</strong> Our results show most of the patients have mild to severe dry eye. Most of the patient presented with dryness, foreign body sensation, itching and Redness. VDG (TV and laptop) contact time of more than 2 hours were associated with increased odds of developing DED.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Polina Dahal, Pradeep Bastola Hemodynamic responses between I-gel and endotracheal tube in patients undergoing laparoscopic surgeries 2022-03-14T22:40:47+00:00 Kiran Adhikari Kriti Devkota Bharati Devi Sharma <p><strong>Background</strong>: Laparoscopic surgeries are commonly performed under general anesthesia using endotracheal intubation. Laryngoscopy and endotracheal intubation cause exaggerated hemodynamic response which may be detrimental to hypertensive patients and those with cardiac issues. I-gel, a second generation supraglottic airway device mitigates this effect and can be safely used under general anesthesia.</p> <p><strong>Methods:</strong> This was a prospective comparative study consisting of 64 patients undergoing laparoscopic surgery. The patients were divided into endotracheal tube group and I-gel group, each group with 32 patients, which was done according to convenience sampling method.&nbsp; Patient’s baseline heart rate, systolic, diastolic and mean arterial blood pressure was recorded. These parameters were recorded at one, three and five minutes of placement of airway device, after creating caboperitonium and after extubation which were compared statistically.</p> <p><strong>Results:</strong> Exaggerated hemodynamic response was observed in endotracheal tube group after endotracheal intubation and immediately after extubation as compared to I-gel group which were more stable. However, both the group had similar hemodynamic response during carboperitonium.</p> <p><strong>Conclusions:</strong> I-gel can be safely used in laparoscopic surgeries under general anesthesia and also lessens the hemodynamic response as compared to endotracheal tube during laryngoscopy and intubation.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Kiran Adhikari, Kriti Devkota, Bharati Devi Sharma (Regmi) Demographic, clinical and virological profile of patients with chronic hepatitis C virus infection 2022-03-14T22:04:50+00:00 Subash Bhattarai Dharm Raj Bhatta Balram Gautam <p><strong>Background</strong>: Chronic Hepatitis C virus (HCV) is a major public health issue worldwide. Chronic HCV is an important cause of cirrhosis and hepatocellular carcinoma. Hepatitis C infection is not uncommon in Nepal. This research was meant to study the demographic, clinical presentation, and virological profile of patients with chronic hepatitis C attending a teaching hospital in Western Nepal.</p> <p><strong>Methods:</strong> A hospital-based, cross-sectional study was conducted over a year from January 2021 and December 2021 among 66 consecutive patients with hepatitis C infection. Demographic and clinical profile of the patients alongside their liver enzymes, viral load, and genotypes at the time of presentation were studied. Descriptive analysis was done using SPSS version 20.</p> <p><strong>Results:</strong> The mean age of subjects was 34±10.42 years with male predominance (M: F=2.3:1).&nbsp; The majority was from rural areas and belonged to low-middle socioeconomic status. Injecting drug use was the most common mode of infection. The majority of patients had no symptoms related to liver diseases. About one-fourth of the patients had cirrhosis of liver. High viral load (HCV RNA&gt; 800,000 IU/ml) was detected in 42.4% patients. The mean HCV RNA was 1348,500 ±1052 IU/ml. Genotype 3a was the most common, followed by genotype 1a.</p> <p><strong>Conclusions:</strong> Hepatitis C virus infection was common in young patients (aged &lt;40 years) especially among injecting drug users. Most of the patients had no symptoms related to liver diseases. Cirrhosis was observed in about one-fourth patients. Genotype 3a was the most common, followed by genotype 1a.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Subash Bhattarai, Dharm Raj Bhatta, Balram Gautam Sonographic measurement of normal uterine dimension in nulliparous adults 2022-03-14T22:54:21+00:00 Prabhat Basnet Pramod Kumar Chhetri Kripesh Thapa <p><strong>Background</strong>: Normal uterine size determination of nulliparous women is very important for the diagnosis of the various uterine pathology. There are different pathologies of uterus but before describing the pathological aspects normal dimension has to be defined. Ultrasound is the first tool for scanning female pelvis pathology. The objective of the study is determining the normal uterine dimension in the nulliparous adults and correlate with the age, height, weight and BMI.</p> <p><strong>Methods:</strong> The study was conducted in Department of Radiology and Imaging College of medical sciences, Bharatpur. Patient presenting with any other symptoms than pelvic cause are included in study with age group (15-25years). All ultrasound examinations were performed using Toshiba Aplio 500. A cross-sectional study is conducted among the 49 patients in College of Medical Sciences, Bharatpur, over the period of one year (November 2020 to October 2021).</p> <p><strong>Results:</strong> Present study showed the mean length, AP diameter, width and volume of the uterus in nulliparous women between the ages of 15-25years. The mean length is 6.88±0.75cm, mean AP diameter is 3.89±0.44cm, mean width is 4.2±0.50 and mean volume is 61.41±16.96 cc. The present study showed the strong correlation between the weight of the patient and uterine dimension, however there is no significant correlation could be established between the age, height and body mass index of the patients with volume uterine dimension.</p> <p><strong>Conclusions:</strong> Normal uterine dimension in Nepalese population is similar to the Nigerian, Scandinavian and Iranian population however the dimensions are smaller than the European population which may be due to the body habitus and genetic factors.&nbsp;&nbsp; There is significant correlation between the weight of patient and volume of the uterus.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Prabhat Basnet, Pramod Kumar Chhetri, Kripesh Thapa Morphometry of distal radius – a radiographic study in Nepalese population 2022-03-14T09:31:00+00:00 Tej Prakash Dawadi Ananda Prasad Regmi Jyoti Sitaula Gaurav Neupane Bishnu Dev Sharma Sanjeeb Rijal Suman Basel Santosh Timalsina Prabha Panthi <p><strong>Background</strong>: Distal radius fractures are common injuries. The outcome of the fractures depends upon the post reduction morphometric parameters. This study was aimed to assess the normal morphometric parameters of distal radius in Nepalese population.</p> <p><strong>Methods:</strong> This was a prospective cross-sectional study of morphometric measurements of 150 distal radius on x rays of wrist joints of patients presenting to department of orthopedics at CMCTH from October 2020 to September 2021. Radial height, Radial inclination, Palmer tilt, Ulnar variance and Radial width in posteroanterior (PA) and lateral views were measured. The data obtained was analyzed to see the difference according to age, sex, side, dominance and ethnicity.</p> <p><strong>Results:</strong> The mean values of Radial height, Radial inclination, Palmer tilt, Ulnar variance and Radial width posteroanterior and lateral were 11.75+-0.94mm, 22.75+-1.50 degrees, 10.51+-1.04 degrees, -0.51 to+-1.15 mm, 27.05+-1.16 mm and 18.7+-1.12 mm respectively.</p> <p><strong>Conclusions:</strong> The distal radius morphometry of Nepalese population is comparable to other national, regional and western similar studies. There were no any statistically significant differences of all the morphometric parameters of distal radius according to age, sex, side, dominance and ethnicity except Radial inclination, according to ethnicity; and Radial width, according to ethnicity and dominance.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Tej Prakash Dawadi, Ananda Prasad Regmi, Jyoti Sitaula, Gaurav Neupane, Bishnu Dev Sharma, Sanjeeb Rijal, Suman Basel, Santosh Timilsina, Prabha Panthi Effect of different anticonvulsants on liver enzyme activities in patients with seizure disorder 2022-03-14T22:40:45+00:00 Arun Dhungana Arun Pandeya Dipesh Shakya Babu Ram Pokharel <p><strong>Background</strong>: Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures, which has transient signs and/or symptoms of abnormal, synchronous neuronal activity in the brain. Antiepileptic drugs (AEDs) used for the prevention of seizure have been found to be an inducer of liver enzyme activity. So, the purpose of this study was to see the effect of antiepileptic drugs on hepatic enzymes activity.</p> <p><strong>Methods:</strong> An observational study was carried out in Kathmandu Medical College from October 2020 to April 2021 at neurology department. Sixty-seven seizure patients aged 19-89 years were included in the study. Liver function test was performed before medication, followed up and monitored for three and six months. Paired sample t-test was used to compare the means by using SPSS version 15.</p> <p><strong>Results:</strong> Among carbamazepine (CBZ) and sodium valproate (VPA) treated cases, 4.5% and 9.1% respectively showed raised Alanine aminotransferase (ALT) activity whereas, 13.6% and 4.5% respectively showed raised Alkaline Phosphatase (ALP) activity. ALT activity was higher in VPA treated patient compared to CBZ treated patient. However, ALP activity was raised in CBZ treated patient compared to VPA treated patients. No, change in liver enzyme activities was observed in patient treated with Levetiracetam</p> <p><strong>Conclusions:</strong> Anticonvulsant drugs used during the treatment have mild to moderate hepatotoxicity. Liver enzyme activity more than two to three-fold may increase. Levetiracetam has minimal hepatic metabolism while sodium valproate is more hepatotoxic. Therefore, routine screening of hepatic enzymes is recommended to the patients under antiepileptic therapy.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Arun Dhungana, Arun Pandeya, Dipesh Shakya, Babu Ram Pokharel Measurement of nasal index in Bhaktapur region: a descriptive cross-sectional study 2022-03-14T22:54:23+00:00 Sarbada Makaju Shradha Adhikari Chandra Kala Rai <p><strong>Background</strong>: The nose is most projection part of the face. Anatomically, the shape of the nose is pyramidal with its apex faces upward and the base faces downwards. It plays an important role in respiration, phonation and aesthetic. The shape of the nose varies according to the different geographical region owing to climate and ethnicity. The aim of this study was to assess the nasal index among the citizens of Bhaktapur.</p> <p><strong>Methods:</strong> The study was conducted on 385 population of Bhaktapur between 1 Aug 2020-Aug 2021. The frequency of the nasal index was analysed. The vernier calliper was used to measure the height and width of nose. The data was analysed by using Statistical Package for the Social Sciences 20 version.</p> <p><strong>Results:</strong> In this study, the highest prevalence of nasal index in Bhaktapur region was mesorrhine 235 (61.0%). In the gender, the highest prevalence of the Nasal Index was mesorrhine. In the ethnicity also mesorrhine types of the Nasal Index was found.</p> <p><strong>Conclusions:</strong> This study concludes that commonest nasal index of the population of Bhaktapur fall under mesorrhine type of nose. The sexual dimorphism was not significant in both the gender as it showed mesorrhine types in both gender. Whereas among the ethnicity, the Brahmin and Newar sharing the almost the same result.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Sarbada Makaju, Shradha Adhikari, Chandra Kala Rai Practice of gowning and gloving technique among health personnel at operation theatre of teaching hospital, Bharatpur 2022-03-14T22:54:24+00:00 Biddhya K.C. Bishnu Bista <p><strong>Background</strong>: Gowning and gloving is regarded as the basic component of modern Surgery, its standard of practice is directly concerned with patient safety and infection prevention. The aim of this study was to observe the practice of gowning and gloving technique among health personnel at operation theatre of teaching hospital, Bharatpur, Nepal.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was carried out among 90 health personnel who had scrubbed in the operation theatre before approached to sterile field, by using observational checklist. Sample was selected by using non probability, consecutive sampling technique. Data were analyzed using descriptive and inferential statistics to find the association between the variable.</p> <p><strong>Results:</strong> The findings highlighted, that only 36.7% of the health personnel fulfill the criteria of surgical gowning and gloving. The main issues found in the study were not picking up the entire folded gown through all layers from the wrapper (31.1%), and not holding the gown near the gown’s neck and touch unsterile objects (18.9%).</p> <p><strong>Conclusions:</strong> The level of practice on gowning and gloving technique was statistically significant with professional experience and education of the respondents. Hence, operation theatre department should develop the audit protocol and in-service training model for the surgical team.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Biddhya K.C., Bishnu Bista Profile of breakthrough infection of COVID-19 in a tertiary care hospital: a descriptive cross-sectional study 2022-03-14T22:04:47+00:00 Khilasa Pokharel Bishwa Raj Dawadi Binod Aryal Lok Bahadur Shrestha <p><strong>Background</strong>: While reports of vaccine induced immunity against COVID-19 have been around, frequency of breakthrough infections is also being reported. The study aimed to analyze breakthrough infections after a complete dose of COVID-19 vaccination.</p> <p><strong>Methods:</strong> Individual who was fully vaccinated with COVID-19 were included in this study. Nasopharyngeal and Oropharyngeal swab was collected and transported to the laboratory as soon as possible for the diagnosis of COVID-19. The specimens were transported in a viral transport medium maintaining cold chain of 2-8°C. Statistical Package for the Social Sciences (SPSS) version 20 was used for data entry and analysis.</p> <p><strong>Results:</strong> Of 8350 samples received 5494 (65.79%) were vaccinated and 2856 (34.20%) were non vaccinated. Among fully vaccinated individuals, 694 (12.63%) are post vaccination COVID-19 cases. Among the post vaccinated COVID-19 cases 264(14.15%), 95(12.70%), 44(3.19%), 28 (1.86%) breakthrough infections are seen among individuals who received Sinopharm, Oxford-Astrazeneca, Johnson and Johnson, other vaccines Pfizer, Moderna, Sputnik V respectively which were tested positive for SARS-CoV-2 RNA on reverse transcriptase polymerase chain reaction.</p> <p><strong>Conclusions:</strong> Laboratory-confirmed COVID-19 cases among vaccinated individuals after complete dose of vaccination indicates that there is still risk of COVID-19. Therefore, regular COVID-19 testing should be conducted even after vaccination.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Khilasa Pokharel, Bishwa Raj Dawadi, Binod Aryal, Lok Bahadur Shrestha Pattern, management and outcome of acute intestinal obstruction at Chitwan medical college teaching hospital 2022-03-14T22:04:49+00:00 Abhishek Bhattarai Pragya Devkota Anup Shrestha Manoj Chand Santosh Timalsina Kishor Kumar Tamrakar Harish Chandra Neupane <p><strong>Background</strong>: Acute intestinal obstruction is one of the commonly encountered emergencies in surgical practice. Gynecological surgery, especially adnexal surgery and hysterectomy has a higher incidence of bowel obstruction as compared to bowel surgery. Conservative management can be done in patients with post-operative adhesive bowel obstruction if there is no evidence of ischemia, bowel necrosis, or perforation. Therefore, a correct diagnosis is essential for appropriate management. We conducted a study to evaluate the etiology, clinical presentation as well as management and outcome of patients presenting with Acute intestinal obstruction at our center.</p> <p><strong>Methods:</strong> This was a retrospective study of all the patients with a diagnosis of Acute intestinal obstruction from January 2015 to December 2019. The diagnosis of Acute intestinal obstruction was made by a combination of clinical and radiological parameters. The data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16. The&nbsp; data&nbsp; were&nbsp; expressed in&nbsp; number and percentage.</p> <p><strong>Results:</strong> During the study period, 178 patients were admitted with the diagnosis of Acute intestinal obstruction. Abdominal pain and vomiting were the main complaints seen in 98.3% (n=175) and 84.8% (n=151) respectively. Hernia (n=49, 27.5%) was the most common cause of acute intestinal obstruction in adults, and Intussusception (n=15, 8.4%) was the leading cause of Acute intestinal obstruction in a pediatric age group. Majority of the patients’ needs (n=148,83.1%) operative intervention to relieve the obstruction. The overall mortality rate was 6.7% (n=12).</p> <p><strong>Conclusions:</strong> Hernia was the most common cause of Acute intestinal obstruction in adults while intussusception was the commonest in the pediatric age group.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Abhishek Bhattarai, Pragya Devkota, Anup Shrestha, Manoj Chand, Santosh Timalsina, Kishor Kumar Tamrakar, Harish Chandra Neupane Level of depression anxiety and stress among health care workers at a tertiary hospital during second wave of COVID in Nepal 2022-03-14T22:04:52+00:00 Sunil Kumar Shah Smita Neupane Kalidas Adhikari Mukesh Mallik <p><strong>Background</strong>: Psychological impact of COVID-19 pandemic on health care workers (HCWs) is a burning issue that needs to be taken care of with utmost importance. The main objective of this study was to assess depression, anxiety and stress among HCWs at a tertiary care hospital dedicated for COVID-19 while fighting with the ongoing second wave of Covid.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was conducted among 245 HCWs at a COVID dedicated hospital in July and August 2021, after IRC approval and with informed written consents. Convenient sampling method was applied. Depression, anxiety and stress scale (DASS) 21 and semi structured proforma were utilized. All the statistical calculations were done by STATA 15.1. Frequency and percentage were calculated as descriptive statistics for baseline characteristics.</p> <p><strong>Results:</strong> Depression was observed in 22.86%, anxiety in 50.61% and stress in 15.51%. Stress was highest among nurses (18.18%), followed by clinicians (16.36%). Anxiety was seen highest among nurses (63.64%) followed by pharmacists (60%). Depression was highly prevalent in nurses (26.57%) compared with clinicians (24.45%) and laboratory staff (6.67%).</p> <p><strong>Conclusions:</strong> Despite developments in the knowledge, management, exposure and experience with COVID-19 since first wave, depression, anxiety and stress has affected health care workers. Therefore, mental health needs of the health care workers have to be taken care of for maintaining a better effective healthy workforce and service delivery.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Sunil Kumar Shah, Smita Neupane, Kalidas Adhikari, Mukesh Mallik Profile of contact lens patients attending to Biratnagar eye hospital, Nepal 2022-03-14T22:04:54+00:00 Pankaj Ray Adhikari Nirmala Chaudhary Rajiv Ranjan Karn <p><strong>Background</strong>: Contact lens is an artificial device whose front surface substitutes the anterior surface of the cornea. The contact lens can be worn to correct vision or for cosmetic or therapeutic reasons. The objective of the study was to determine the profile of contact lens patients attending Biratnagar Eye Hospital, Nepal.</p> <p><strong>Methods:</strong> The hospital-based cross-sectional study was done. All the patients referred to the contact lens clinic of Biratnagar Eye Hospital, Nepal for a contact lens trial were included in this study between 1st January 2016 to 31st December 2019. Data were collected by an optometrist trained in contact lens care and descriptive analysis was performed by using SPSS -17 versions.</p> <p><strong>Results:</strong> The mean age (±SD) of the patient was 22.9 (±9.6). Most of them were male 178 (55%) and from India 234 (72%). The majority of patients were in the age between 19 to 40 years 194 (60%). Keratoconus 253 (39%) was the most common ocular disorder found followed by myopia 138 (21%) and astigmatism 56 (9%). Most of the eyes had high refractive errors 287 (44%). Contact lens trial was done in 535 (82%) eyes and it was used for optical correction in 455 (70%) eyes. Rigid Gas Permeable 271 (51%) contact lens was mostly tried followed by soft contact lens 194 (36%). After using a contact lens, 548 (84%) eyes got normal visual acuity.</p> <p><strong>Conclusions:</strong> Keratoconus was the most common ocular disorder found followed by myopia and Astigmatism. Rigid Gas Permeable contact lens was mostly prescribed for vision correction. There was a significant improvement in visual acuity after giving contact lenses.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Pankaj Ray Adhikari, Nirmala Chaudhary, Rajiv Ranjan Karn Pathway to care among clients attending at psychiatric out patient department of a teaching hospital, Bharatpur 2022-03-14T22:40:44+00:00 Sindu Pokharel Ramesh Subba Hem Kumari Subba <p><strong>Background</strong>: Mental illnesses cause significant suffering around the world. A limited number of people with psychiatric problems seek treatment in healthcare facilities when their condition is severe only. Treatment by faith healers and unqualified medical practitioners is frequent which lead to the delay in proper treatment. The objective of the study was to identify the pathway to care among clients attending at Psychiatric Outpatient Department of Chitwan Medical College, Teaching Hospital, Bharatpur.</p> <p><strong>Methods:</strong> Descriptive cross-sectional design was used and 166 clients attending at psychiatric OPD of Chitwan Medical College, Teaching Hospital were selected by using non-probability, consecutive sampling technique. Data were collected from 11th August 2019 to 6th September 2019 through face to face interview method using structured interview schedule. Collected data were further analyzed in SPSS version 23 using descriptive and inferential statistics</p> <p><strong>Results:</strong> The finding of the study revealed that 54.2% of clients first visited faith healer for initial treatment and only 16.9% visited psychiatrist directly for the treatment. Similarly, 53.6% of clients visited other personnel than psychiatrist due to their cultural belief and 59.6% of the clients had adequate level of awareness towards mental illness. Significant association was found between status of pathway to care and client’s sex, ethnic group and occupation.</p> <p><strong>Conclusions:</strong> It is concluded that mental illness clients first approached faith healer for their initial treatment due to their cultural belief. It is important that traditional healers and other treatment providers must be aware of and recognize the mental illnesses in order to treat mental patients early and refer to psychiatrist.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Sindu Pokharel, Ramesh Subba, Hem Kumari Subba Pharyngeal airway space in different skeletal malocclusion and facial forms 2022-03-14T17:54:44+00:00 Gaurav Acharya Rosha Shrestha Abhishek Gupta Surendra Acharya <p><strong>Background</strong>: Evaluation of the upper and lower airway space should be an integral part of diagnosis and treatment planning to achieve the functional balance and stability of the result after orthodontic or orthognathic treatment. This study aimed to analyze the pharyngeal airway space in different skeletal malocclusion and facial forms.</p> <p><strong>Methods:</strong> Study was carried out in lateral cephalometric radiographs of 210 patients. Data was collected from March 2021 to December 2021. Pharyngeal airway spaces were analyzed according to McNamara Analysis. Upper and lower pharyngeal airway in different skeletal malocclusion and facial form was determined. Data was analyzed in SPSS version 20. Independent samples-t test was applied for gender distribution and Pearson correlation test was applied for upper and lower pharyngeal space.</p> <p><strong>Results:</strong> The mean value of upper pharyngeal airway width in Class I, II and III were 12.07 mm, 11.57 mm and 12.34 mm respectively and for Mesofacial, Dolichofacial and Brachyfacial facial form were 12.35 mm, 11.83 mm and 11.81 mm respectively. Similarly, the mean value for lower pharyngeal airway width in Class I, II and III were 9.51 mm, 9.13 mm and 10.03 mm respectively and for Mesofacial, Dolichofacial and Brachyfacial facial form were 9.62 mm, 9.34 mm and 9.61mm respectively. Male had higher value of mean lower pharyngeal width than female.</p> <p><strong>Conclusions:</strong> There was no impact of sagittal skeletal malocclusion on the upper and lower airways width. Also, there was no impact of different vertical skeletal types or facial forms on the upper and lower airways width.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Gaurav Acharya, Rosha Shrestha, Abhishek Gupta, Surendra Acharya Study of oxygen delivery methods use in the COVID-19 patients 2022-03-14T16:46:32+00:00 Pratik Wagley Shital Adhikari Madhur Dev Bhattarai Basanta Gauli Sailesh Gurung Sunil Patel Niraj Puri <p><strong>Background</strong>: The oxygen crisis globally during the Corona virus disease-19 (COVID-19) pandemic reflected the need of appropriate and economic use of oxygen in its management. There is scarce report of the use of different oxygen delivery methods (ODMs) in COVID-19 patients in our region.&nbsp;&nbsp;</p> <p><strong>Methods:</strong> This was a hospital-based observational study conducted from July 2021 to October 2021. We studied various ODMs used by 100 COVID-19 patients, aged 18 years or above admitted to Chitwan Medical College and Teaching Hospital during July to October 2021 and the trend of how the ODMs changed during the hospital stay. Data analysis was done by SPSS version 20 for Windows. Fisher’s exact and Kruskal Wallis tests were used to analyze the data of the participants.</p> <p><strong>Results:</strong> In our study, oxygen supplementation at presentation using nasal cannula was required by 74% of patients, face mask by 13%, Venturi mask 34%, non-rebreathing mask 25%, high-flow nasal cannula 27%, non-invasive ventilation 6%, and invasive mechanical ventilation by 21%. There was significant difference in the use of ODMs at presentation among the moderate, severe and critical COVID-19 groups (P&lt;0.001). There was a wide range of switching between various ODMs during the treatment course.</p> <p><strong>Conclusions:</strong> Nasal cannula was the most common ODM followed by venturi devices and invasive mechanical ventilation. Despite varying oxygen flow requirements, aerosol risks, merits and limitations of different ODMs, they can be appropriately used in various COVID-19 management situations. Besides inspired oxygen concentration and oxygen flow, patients’ condition, tolerance and availability of the resource also affected the choices of ODMs to achieve the correction of hypoxemia.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Pratik Wagley, Shital Adhikari, Madhur Dev Bhattarai, Basanta Gauli, Sailesh Gurung, Sunil Patel, Niraj Puri Lingual nerve in relation to mandibular third molar region: a cadaveric study 2022-03-14T16:46:34+00:00 Usha Chalise Rabita Kharbuja Shaligram Dhungel Kushal Bimb <p><strong>Background</strong>: The lingual nerve is the terminal branch of the mandibular division of trigeminal nerve. The spatial relationship of lingual nerve to the mandibular alveolar crest varies widely. This variation can be among the gender, age, dental status and between the right and left side of the same sample. This study was aimed to determine the relationship of lingual nerve to mandibular third molar region.</p> <p><strong>Methods:</strong> An observational study was carried out from January 2021 to December 2021.The study sample was 15 cadavers including both right and left sides. The lingual nerve was exposed by dissecting the infra temporal region following the standard procedures of Cunninghams Manual of Dissection. The diameter of the lingual nerve, vertical and horizontal distance were measured. The results of all these measurements were tabulated and mean standard deviation were calculated using SPSS version 16.</p> <p><strong>Results:</strong> Out of 30 lingual nerves examined, the mean horizontal distance was 3.99 ± 0.96 mm, the mean vertical distance was 12.67 ± 1.76 mm while the diameter of the lingual nerve was 2.46 ± 0.54 mm.</p> <p><strong>Conclusions:</strong> The lingual nerve always lies in close proximity of alveolar bone and surgeons operating in this region need to be aware during any surgical interventions or any procedures in this region.&nbsp; A thorough apprehension of the spatial location of the lingual nerve enable to lessen the lingual nerve injury.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Usha Chalise, Rabita Kharbuja, Shaligram Dhungel, Kushal Bimb Satisfaction and utilization patterns of social security allowance among senior citizen in Bharatpur ward no-6, Nepal 2022-03-14T17:15:17+00:00 Eak Narayan Poudel Gayatri Khanal Subash Koirala <p><strong>Background</strong>: The quality of the senior citizens has become a public health concern. The Quality of the life of senior citizen is affected by many factors. Among them one of the strong factors is social security allowance. Misuse on social security allowance and dissatisfaction is increasingly recognized among senior citizens hence, the present study aimed to explore satisfaction with and utilization of the old age allowance among older people.</p> <p><strong>Methods:</strong> The Community based cross-sectional study using face to face interview was carried out among senior citizen in Bharatpur Metropolitan ward no -6. Asystematic Random sampling method was used. We used IBM Statistical software version 20 to carry descriptive and bivariate analysis.</p> <p><strong>Results:</strong> Around 134(77.4%) respondent mentioned that, they were capable to spend their Social Security Allowance themselves. Senior citizen was satisfied with the social security allowance given by government while 38.7% were unsatisfied. Satisfaction status of social security allowance significantly associated with living condition [with familymembers (COR=3.18; CI=1.54-6.57)], occupation[other than farm (COR=2.18; CI=1.16-4.09)]</p> <p><strong>Conclusions:</strong> The Social security Allowance for senior citizen is a necessary and proper utilization can give important contribution to older people connected with family and community.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Eak Narayan Poudel, Gayatri Khanal, Subash Koirala High resolution computed tomography chest findings during admission and follow-up in severe COVID-19 infection 2022-03-14T16:52:41+00:00 Niraj Puri Shital Adhikari Madhur Dev Bhattarai Basanta Gauli Sailesh Gurung Sunil Patel Pratik Wagley Deepak Adhikari Bigyan Paudel <p><strong>Background</strong>: The full extent of pulmonary damage and long-term prognosis due to severe COVID-19 pneumonia is still unclear. This study was aimed to characterize and compare changes in the radiological pattern of HRCT chest in severe COVID-19 pneumonia patients from admission to that of follow-up.</p> <p><strong>Methods:</strong> This was a one-year prospective study done at Chitwan Medical College from April 2020 to April 2021. Total 56 patients with severe COVID-19 pneumonia who had at least one HRCT chest during admission and another during follow-up within 5 weeks. Based on the total number of days on systemic steroids, patients were separated into three follow-up groups. Statistical Package for Social Science version 20 was used for data input and descriptive analysis. Point estimate at 95% Confidence interval was calculated along with frequency and descriptive statistics.</p> <p><strong>Results:</strong> The median CT severity index scores of follow-up HRCT chest improved from 14.5 to 10.0 in the 3rd week and from 16.0 to 11.5 in the 5th week. Ground Glass Opacity resolved early and steadily. The prevalence of bronchiectasis and fibrosis was considerable, with no meaningful improvement up to 5th week.</p> <p><strong>Conclusions:</strong> Significant radiological improvement can be seen as early as 3rd week from recovery phase of severe COVID-19 pneumonia where systemic steroids have a key contributory role. High frequency of bronchiectasis and fibrosis from in-patient HRCT chest may be due to acute COVID-19 pneumonia lesions on the preexisting undiagnosed lung diseases which may be falsely ascribed to the post-COVID.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Niraj Puri, Shital Adhikari, Madhur Dev Bhattarai, Basanta Gauli, Sailesh Gurung, Sunil Patel, Pratik Wagley, Deepak Adhikari, Bigyan Paudel Evaluation of students’ perceptions and feedback about teaching-learning pharmacology in a medical college of central Nepal 2022-03-14T16:46:31+00:00 Karma Murti Bhurtyal Sirisa Karki Gita Paudel Sanjay Raj Baral Ashish Gautam Roshan Kumar Chaurasia Unisha Khanal <p><strong>Background</strong>: Learners’ feedback is considered an effective tool in evaluating teaching-learning methods and revising curriculum. The aim of the present study was to assess perception and feedback of undergraduate medical students towards teaching-learning pharmacology.</p> <p><strong>Methods:</strong> This was a descriptive cross-sectional questionnaire-based study conducted among 183 undergraduate medical students of Chitwan Medical College, Chitwan Nepal from March 2021 to April 2021.. Perception and feedback of students towards teaching-learning pharmacology was assessed using a pretested and validated questionnaire.</p> <p><strong>Results:</strong> More than half (53.6 %) of the students reported pharmacology as their favorite subject, but only 27.4 % students would opt to pursue post-graduation in the same subject. Majority of the students opined a review of curriculum was necessary with inclusion of recent advances (86.4 %) and emphasis on national health problems (83 %) with a change in assessment (inclusion of multiple choice questions) (83 %). Liquid-crystal display (LCD) projector and whiteboard combined was chosen as the ideal teaching-learning media and group discussion as the ideal teaching-learning method by 85.2 % and 53.6% of students respectively. Majority of the students suggested more use of audio-visual aids (94.5%) and inclusion of case-based learnings (98.9 %) into the curriculum.</p> <p><strong>Conclusions:</strong> Perception of students towards teaching-learning pharmacology was positive. A review of the current curriculum with inclusion of a new assessment tool was suggested.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Karma Murti Bhurtyal, Sirisa Karki, Gita Paudel, Sanjay Raj Baral, Ashish Gautam, Roshan Kumar Chaurasia, Unisha Khanal Relationship of outcomes between different etiologies and severity groups of patients presenting with acute febrile illness with transaminitis 2022-03-14T09:22:27+00:00 Sunil Kumar Patel Shital Adhikari Madhur Dev Bhattarai Basanta Gauli Sailesh Gurung Pratik Wagley Niraj Puri Anjana Lamichhane <p><strong>Background</strong>: Acute febrile illness (AFI) is defined as a fever lasting less than 14 days with no evidence of organ-specific symptoms or signs of infection. Our aim was to determine the most common etiology of AFI with transaminitis and to find the relationship between clinical and laboratory investigation profile, as well as outcomes of illness.</p> <p><strong>Methods:</strong> This is a hospital based prospective study conducted in Chitwan Medical College and Teaching Hospital (CMC-TH) from 17 April 2021 to 18 October 2021. All patients &gt;15 years of age admitted with acute febrile illness and elevated transaminases under Pulmonary and Critical Care Medicine (PCCM) Unit of CMCTH were enrolled consecutively.</p> <p><strong>Results:</strong> The mean age of the patients (n=103) was 45.1 ± 16.8 years. There were almost equal proportion of males and females. The most common presenting symptom (besides fever) was headache, followed by myalgia, with a median duration of 5 days. Scrub typhus was the commonest diagnosis (60, 58.3%). A diagnosis of Acute Undifferentiated Febrile Illness (AUFI) was given in (39, 37.9%) patients. The three transaminitis severity groups (mild, moderate and severe) were not significantly different by age, gender and comorbidity status. Acute kidney injury and multi-organ dysfunction syndrome (MODS) were significantly associated with severe transaminitis (P&lt;0.05). The mortality rate was also higher in the severe transaminitis group.</p> <p><strong>Conclusions:</strong> Scrub typhus has emerged as the most common cause of Acute Febrile Illness with transaminitis requiring hospital admission in this part of the country. Scrub typhus should be suspected in all patients who report with AFI with transaminitis in endemic areas.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Sunil Kumar Patel, Shital Adhikari, Madhur Dev Bhattarai, Basanta Gauli, Sailesh Gurung, Pratik Wagley, Niraj Puri, Anjana Lamichhane Comparison of total serum bilirubin and transcutaneous bilirubin in neonates with hyperbilirubinaemia 2022-03-14T11:54:57+00:00 Sandeep Shrestha Binod Man Shrestha Bina Prajapati <p><strong>Background</strong>: Jaundice is considered as one of the most prevalent and common clinical problems during neonatal period which may require interventional treatment. Transcutaneous bilirubinometry is a simple method for estimating bilirubin levels and diagnosing jaundice in neonates. This study was done to compare transcutaneous bilirubin and total serum bilirubin in jaundiced neonates.</p> <p><strong>Methods: </strong>A hospital based prospective cross-sectional study of neonates from Out Patient Department, Emergency Ward, and Neonatal Intensive Care Unit with clinical jaundice was conducted between January 2016 and December 2016, at Kanti Children’s Hospital, Maharajgunj, Nepal. A total of 162 neonates were interviewed using preformed questionnaires. Then the correlation between the transcutaneous bilirubin and plasma bilirubin level was assessed by linear regression analysis. It was then analyzed with the help of SPSS Version 20. p-value &lt;0.05 was considered statistically significant.</p> <p><strong>Results: </strong>Out of 162 cases, 61.7% were males and 38.3% were females. There was a high correlation between TcB and TSB level in neonates (r = 0.981) and this finding was statistically significant (p-value&lt;0.001). Correlation coefficient of 0.98 and 0.97 were found in term and preterm neonates respectively, which suggested strong correlation between TcB and TSB in both groups of neonates.</p> <p><strong>Conclusions: </strong>Transcutaneous bilirubin measurement can be considered as a suitable tool for predicting neonatal bilirubinemia as it has high sensitivity.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Sandeep Shrestha, Binod Man Shrestha, Bina Prajapati Article processing charges - a challenge for researchers in Nepal 2022-03-14T08:44:52+00:00 Pathiyil Ravi Shankar Nisha Jha <p>NA</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Pathiyil Ravi Shankar, Nisha Jha Combination therapy for the management of mucocele and ranula in children: case series 2022-03-14T09:15:50+00:00 Amita Rai Bandana Koirala Mamta Dali Sneha Shrestha <p>Mucoceles and ranulas are common cystic lesions affecting the oral mucosa. They typically appear as bluish, often fluctuant, nontender submucosal masses with a normal overlying mucosa. Combination therapy, comprising of micromarsupialization with intralesional steroid administration is a conservative management technique for the management of large mucoceles and ranulas. This case series reports three cases, in which combination therapy was chosen for the management of a large mucocele and ranulas in six, seven and nine-year-old children, respectively. There was complete resolution of all the swellings with no recurrence in any of the cases until the six months follow-up visit. Combination therapy showed promising outcomes as a conservative treatment modality, especially in pediatric population for the management of large mucoceles and ranulas.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Amita Rai, Bandana Koirala, Mamta Dali, Sneha Shrestha Giant peripheral ossifying fibroma of the mandible: case report of a rare and distinct pathology 2022-03-14T09:12:28+00:00 Ashutosh Kumar Singh Nikita Khanal <p>Peripheral ossifying fibroma usually presents as a small, pedunculated, gingival nodule, the pathogenesis of which is believed to be reactive rather than neoplastic. The lesion is typically less than two cm in size; however, there are reported cases where the lesion grew quite large. The oversize mass-like clinical appearance might be confused for other similar neoplastic lesions of the oral cavity, and the radiographic presentation of soft tissue calcification may lead to misdiagnosis; however, the histological features are diagnostic. There are very few cases reported of a giant POF; hence, we present a new case of a giant mandibular POF that was managed with resection and reconstruction. A brief review of previously reported cases on the clinical presentation, radiographic features, treatment modalities, and outcomes is performed to inform clinical decision making. This lesion represents a distinct clinical entity with a set of features requiring recognition for accurate diagnosis and a radical management approach due to its aggressive growth and a high recurrence rate.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Ashutosh Kumar Singh, Nikita Khanal Rare blood transfusion hazard-TRALI: a case report 2022-03-14T09:19:23+00:00 Prerana Bhattarai Junu Shrestha Dipesh Upreti <p>Transfusion related acute lung injury is a rare life-threatening complication of blood transfusion. The diagnosis is done clinically as there are no distinguishing biomarkers. We report a case of 25 years old female with six weeks of gestation with ruptured ectopic, who presented to the emergency department with acute abdominal pain. She underwent emergency laparotomy and received two units of blood transfusion post-operatively. Eight hours after surgery and six hours following blood transfusion, the patient developed fever (1010 F), tachycardia (&gt; 140 bpm) and respiratory distress (SPO2: &lt;80%, Respiratory rate: &gt;30 per minute). The diagnosis of transfusion related acute lung injury was made and managed accordingly in Intensive Care Unit. Being a potentially life-threatening complication of the blood transfusion, early clinical diagnosis and further management is crucial to prevent fatal outcome.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Prerana Bhattarai, Junu Shrestha, Dipesh Upreti Between Scylla and Charybdis: academic publishing during the ongoing pandemic 2022-03-14T08:49:13+00:00 Pathiyil Ravi Shankar <p>The ongoing coronavirus pandemic has led to an increased volume of submissions. Many journals have special issues and accelerated peer review for these articles. Maintaining the speed and rigor of the process during the pandemic can be challenging. There have been prominent retractions, predatory journals may have exploited the situation and topics other than the pandemic may be neglected. Peer reviewers are overworked and are also busy providing patient care. We should navigate carefully between ensuring timely publication and ensuring the quality of the published manuscripts. In this article I put forward twelve suggestions to support this process.</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Pathiyil Ravi Shankar Evolution of tobacco epidemic - where are we heading? 2022-03-14T08:42:19+00:00 Pranil Man Singh Pradhan <p>NA</p> 2022-03-15T00:00:00+00:00 Copyright (c) 2022 Pranil Man Singh Pradhan