Journal of Chitwan Medical College <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> Chitwan Medical College en-US Journal of Chitwan Medical College 2091-2412 Research oriented medical school curricula to nurture undergraduates in preparation for the future physician scientists: relevance for developing countries <p>N/A</p> Jay Shah Gehanath Baral Ganesh Dangal Harish Chandra Neupane Copyright (c) 2021 Jay Shah, Gehanath Baral, Ganesh Dangal, Harish Chandra Neupane 2021-09-30 2021-09-30 11 3 1 5 Sunlight and SARS-CoV-2: can sunlight and UV exposure mitigate the propagation of COVID-19? <p><strong>Background: </strong>This review aims to assess the contributing role of sunlight on mitigating the propaga­tion of COVID-19, and to assess how sunlight as well as artificial UV light may be a natural, more cost effective and eco-friendly method of disinfection which can be implemented in order to help to combat this rampant pandemic.</p> <p><strong>Methods: </strong>An extensive literature survey of English literature was conducted using Pubmed, Pubmed Central, Medline, Google Scholar and WHO Nepal Situation Updates on COVID-19. A combination of keywords was entered: “Sunlight” OR “Disinfection”; OR “Ultraviolet Rays”; OR “SARS-CoV-2”; OR “Coronavirus Disease 2019”; OR “COVID 19”; AND ‘Nepal’.</p> <p><strong>Results: </strong>Sunlight is composed of UVA (95%) and UVB (5%) radiation, UVB is most effective to inac­tivate SARS-CoV-2 and does so by damaging the RNA genome of the virus, and increasing levels of reactive oxygen species in the air. SARS-CoV-2 is nullified by a UVB flux of 28 J/m2, and needs to be exposed for a sufficient duration depending on the time of day, season, geographic location or the specific locality, in order to be inactivated.</p> <p><strong>Conclusion: </strong>Developing countries could benefit from taking advantage of using sunlight as a cost-free and environmentally friendly method of disinfection. It is imperative that all countries capital­ize on this method of disinfection, it is cost-free, easy and therefore can be implemented on a large scale with relative ease.</p> Alexandra Leclézio Jared Robinson Indrajit Banerjee Copyright (c) 2021 Alexandra Leclézio, Jared Robinson, Indrajit Banerjee 2021-09-30 2021-09-30 11 3 126 131 Awareness on cervical cancer and practice of pap smear test among the married women of Changunarayan municipality <p><strong>Background</strong>: Cervical cancer is the fourth most common cancer among women globally. It can be cured if diagnosed at an early stage and treated promptly. This study aimed to find out the awareness on cervical cancer and practice of Pap smear test among the married women of Changunarayan Municipality.</p> <p><strong>Methods: </strong>A descriptive cross-sectional study design was carried out in Changunarayan Municipality among 115 purposively selected married women aged between 30 to 60 years. The data was collected from 1stJuly 2021 to 21thJuly 2021. Data was collected by using semi structure interview schedule through face-to-face interview method. Descriptive as well as inferential statistics was used to describe the findings and measure the association between variables.</p> <p><strong>Results: </strong>Among the total respondents, 52.2% had inadequate level of awareness and 47.8% had adequate level of awareness in cervical cancer. Regarding the practice, only 20.9% of respondents had done Pap smear test. There is no significant association between level of awareness of cervical cancer with practice of Pap smear test, age, educational status, occupation, age at marriage and age at first child birth of the respondents.</p> <p><strong>Conclusions: </strong>It is concluded that women had adequate awareness in cervical cancer however; the practice of performing Pap smear test was low. The level of awareness of cervical cancer did not influence the practice of Pap smear test.</p> Mamata Bharati Gita Dhakal Chalise Ambu KC Sushmita Khadka Nisha Bharati Laxmi Lakhaju Copyright (c) 2021 Mamata Bharati, Gita Dhakal Chalise, Ambu KC, Sushmita Khadka, Nisha Bharati, Laxmi Lakhaju 2021-09-30 2021-09-30 11 3 6 10 University student’s attitude towards virtual learning during COVID-19 pandemic in Nepal <p><strong>Background</strong>: COVID-19 has put huge impact on our day to day life. Needless to say, the lockdown has hugely affected the education system as well. The purpose of this study was to assess students’ perceptions and attitude toward virtual learning among undergraduate and graduate students of Nepal.</p> <p><strong>Methods: </strong>A web-based cross-sectional study using Google form was conducted among 438 undergraduate and postgraduate students of various universities of Nepal under various academic programs. A structured questionnaire consisting of 15 items (5-point Likert scale) was distributed to the students using Google Form. Data was collected from October 2020 to December 2020. Data was analyzed by using SPSS and analyzed using descriptive statistical tools.</p> <p><strong>Results: </strong>Among 438 students, more than half of the students had a positive attitude towards virtual learning. Most of the students used Zoom as a mode of application in virtual learning. More than one-third of the students found online classes effective only for theoretical subjects rather than numerical and practical subjects. More than 70% of students agreed that virtual learning could be taken as an alternative source for learning in the future. More than half of the students faced the problem of the internet during virtual learning.</p> <p><strong>Conclusions: </strong>The significance of virtual learning is rising as the academic year has been disrupted due to COVID-19. Although online learning is a new method of learning that is being adapted due to COVID-19, the satisfaction level of most of the students was found to be good. The students agreed on using the distance learning approach in the future to enhance their knowledge.</p> Hari Prasad Upadhyay Pallavi Koirala Prativa Sedain Copyright (c) 2021 Hari Prasad Upadhyay, Pallavi Koirala, Prativa Sedain 2021-09-30 2021-09-30 11 3 11 15 Oral health status among pregnant and nonpregnant women: a comparative study <p><strong>Background</strong>: Physiological alterations manifesting during pregnancy may influence oral health of women by increasing the susceptibility to oral infections. This study was carried out to assess oral hygiene status, gingival status, periodontal status and treatment needs (TNs) among pregnant and nonpregnant women.</p> <p><strong>Methods: </strong>A comparative cross-sectional study was conducted in patients attending Outpatient Depart­ment of Obstetrics and Gynaecology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chit­wan, Nepal from December 2020 to June 2021. A total of 102 pregnant (34 in each trimester) and 102 nonpregnant women of 15-49 years fulfilling all inclusion criteria were evaluated for oral health status by various indices including oral hygiene index-simplified (OHI-S), gingival index (GI), and community periodontal index and treatment needs (CPITN). Convenience sampling technique was done. Data was analysed in SPSS v.26.0.</p> <p><strong>Results: </strong>The mean scores of OHI-S, GI and CPITN were statistically (p value&lt;0.001) higher in pregnant women compared to nonpregnant women; highest in third trimester followed by second and first tri­mesters. In both groups, majority were found to have score 2 for treatment needs. TN2, encompassing oral hygiene instructions and oral prophylaxis was required by 92.2% of nonpregnant women, 100% of pregnant women in first trimester, 88.2% and 5.9 % in second and third trimesters respectively. Majority (94.1%) of pregnant women in third trimester required TN3 complex treatment.</p> <p><strong>Conclusions: </strong>Pregnant women found to have poor oral hygiene status, more gingivitis and periodontal diseases as compared to nonpregnant women. Implementation of proper oral hygiene practices can pre­vent oral diseases and its further complications.</p> Shristi Kafle Harender Singh Basant Sharma Copyright (c) 2021 Shristi Kafle, Harender Singh, Basant Sharma 2021-09-30 2021-09-30 11 3 16 20 Factors influencing teenage pregnancy among dalit ethnic groups in Bharatpur Metropolitian city, Chitwan <p>&nbsp;<strong>Background</strong>: Teenage pregnancy refers to any pregnancy from a girl who is 10-19 years of age. This study aimed at accessing the factors influencing teenage pregnancy at first birth among the Dalit ethnic groups in Bharatpur Metropolitan City.</p> <p><strong>Methods: </strong>A community based cross-sectional study using face-to-face interview method was carried out in Bharatpur Metropolitan City, Chitwan, Nepal. A total of 217 married Dalit women who had given birth to at least one child and who were less than 25 years of age during the survey were considered as a sample. The data was collected from October 1st 2020 to 31st December 2020. We used Pearsons Chi-square test and binary logistic regression analysis to assess the factors influencing teenage pregnancy among Dalit ethnic groups in Bharatpur Metropolitan city, Chitwan.</p> <p><strong>Results: </strong>Among 217 married women of Dalit ethnic groups, there were 93(42.9%) married women who gave birth to their first child during teenage years and 124(57.1%) women gave first birth after crossing the teenage years. Results show that teenage pregnancy at first birth differ significantly with mother’s education level [Just Literate (OR = 5.88; CI = 2.53-13.69)], Husband’s education level [Just Literate (OR = 3.06; CI = 1.33-7.02)], Husband’s occupation [Unemployment (OR = 7.87; CI = 2.17-28.46)] and Husband’s age at marriage [ ≤ 20 (OR = 6.01 CI = 3.27-11.06)].</p> <p><strong>Conclusions: </strong>Carrying out advocacy against teenage marriage &amp; teenage pregnancy as well as implement­ing comprehensive sexuality education and safe motherhood education targeted to Dalit ethnic groups is the need of the hour.</p> Subash Koirala Eak Narayan Poudel Arun Koirala Niki Shrestha Copyright (c) 2021 Subash Koirala, Eak Narayan Poudel, Arun Koirala, Niki Shrestha 2021-09-30 2021-09-30 11 3 21 25 COVID-19 factors and mental health associated with psychological distress level among dentists and dental hygienists in Nepal <p><strong>Background</strong>: The COVID-19 pandemic, which is caused by a severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), is acknowledged an unprecedented crisis that has adversely affected the population globally and created a situation of emergency in health systems worldwide. The aim of present study was to evaluate the association of COVID-19 factors and psychological factors with psychological distress level among dental professional of Nepal.</p> <p><strong>Methods: </strong>The data was collected through a cross-sectional survey conducted online among 350 dental practitioners in Nepal. The data was collected during the period of December 2020 to April, 2021. A self-measuring questionnaire was prepared throgh Google forms to assess COVID-19 factors. In psychological factors category, self-efficacy and subjective overload was measured. General self-efficacy scale was used for the evaluation of self-efficacy and Demand-Scale (short-version) was used for measuring the subjective overload. Kesslers’ K6 scale was used for assessing the distress level among the participants of the study. Multivariate logistic regression was used for statistical analysis.</p> <p><strong>Results: </strong>Findings of the study revealed that elevated psychological distress was found more among female dental staff, having fear of contracting COVID-19 from patient, and who have shown higher subjective overload. Lower psychological distress was associated with higher work-experience, and in those who got higher scores for self-efficacy.</p> <p><strong>Conclusions: </strong>This study was conducted during the outbreak of deadly infectious coronavirus disease. While exploring the COVID-19 factors and psychological factors on the distress level among dental staff, it is warranted as the effects may be long-term because of their psychological implications on the mental health of dental practitioners.</p> Harender Singh Sanjeeb Chaudhary Smriti Narayan Thakur Abhishek Gupta Copyright (c) 2021 Harender Singh, Sanjeeb Chaudhary, Smriti Narayan Thakur, Abhishek Gupta 2021-09-30 2021-09-30 11 3 26 30 Factors affecting self-directed learning readiness of the undergraduate nursing students from Purbanchal university, Nepal: a cross-sectional study <p><strong>Background</strong>: Self-directed learning is a higher educational learning paradigm where learners take both learning initiatives and evaluate learning outcomes. Since students have control over their own learning, they can understand their own strengths, interests, limitations and style of receiving new information. The objective of this study was to assess the factors associated with self-directed learning readiness of the undergraduate nursing students from the nursing school of Purbanchal University.</p> <p><strong>Methods: </strong>A descriptive, cross-sectional study was conducted from January 2019 - August 2020 among undergraduate nursing students from Purbanchal University School of Health Sciences where 253 students participated. Census sampling method was adopted. Ethical clearance was taken from Institutional Review Committee of Purbanchal University School of Health Sciences. Self-administered, valid and standard tool i.e. Williamson’s Self Rating Scale for Self-directed Learning (SRSSDL) was used. Data was collected using online google forms and analysis was done with SPSS 16.0 version using mean, median, standard deviation, range, chi-square test, and multivariate logistic regression analysis at p&lt;0.05.</p> <p><strong>Results: </strong>Overall Self-directed Learning score was 244.58±31.93. Majority of the respondents (79.1%) had high scores of SRSSDL (221-300) and 20.9% of the respondents had moderate scores of SRSSDL (141-220). On bivariate analysis, the marital status of the students (p= 0.025) and grade/division in the previous academic year (p= 0.013) exerted significant association on the overall level of SRSSDL. On multivariate analysis, the unmarried students had 4.298 times higher odds of having higher scores of SRSSDL (AOR: 4.298; CI: 1.28-14.18).</p> <p><strong>Conclusions: </strong>Overall self-directed learning readiness among the nursing students was moderate to high. Only the marital status was the significant factor affecting the SRSSDL among the nursing students.</p> Namu Koirala Shyam Prasad Kafle Anupam Koirala Copyright (c) 2021 Namu Koirala, Shyam Prasad Kafle, Anupam Koirala 2021-09-30 2021-09-30 11 3 31 35 Sonographic evaluation of the cervical lymphadenopathy with pathological correlation <p>&nbsp;<strong>Background</strong>: Enlarged cervical nodes are very common presentation in radiology department. The accurate diagnosis of the cervical lymphadenopathy is very crucial for further management. The aim of this study was to evaluate the cervical lymphadenopathy by sonography and see the effec­tiveness of B mode ultrasound and color Doppler ultrasound in differentiation between the benign and malignant lymph nodes.</p> <p><strong>Methods: </strong>A retrospective study was conducted in the Department of Radiology, College of Medical sci­ences, Bharatpur from 2019 to 2021 among 40 patients with clinically palpable cervical nodes. The so­nographic findings and FNAC/biopsy correlation were done with calculation of the p value, sensitivity, specificity, positive and negative predictive values. SPSS 20.0 and Microsoft Excel were used for the data analysis and presentation.</p> <p><strong>Results: </strong>Among 40 patients the most common diagnosis was tuberculosis nodes followed by reactive nodes, metastatic nodes and lymphomatous nodes. The sensitivity and specificity for reactive nodes is very high 92% and 89% respectively for B-mode and for color Doppler ultrasound it is 82% and 90%. For TB nodes and metastatic nodes B-mode and color Doppler ultrasound has low sensitivity and high specificity 72% and 71% sensitivity for TB and metastatic nodes respectively and 91% and 94% specificity for TB and metastatic nodes respectively.</p> <p><strong>Conclusions: </strong>B mode and color Doppler sonography is very helpful to accurately diagnose the cause of cervical lymphadenopathy with high specificity and sensitivity. However, the differentiation between the tubercular, metastatic and lymphomatous nodes by sonography is very difficult and requires FNAC/biopsy correlation.</p> Prabhat Basnet Pramod Kumar Chhetri Copyright (c) 2021 Prabhat Basnet, Pramod Kumar Chhetri 2021-09-30 2021-09-30 11 3 36 40 Study on cost variation of oral antihypertensive medications available in retail stores across Chitwan <p><strong>Background</strong>: Antihypertensive medications reduce blood pressure and decrease cardiovascular dis­ease morbidity and mortality. A number of antihypertensives with same formulation but different prices are available in the market. In the present study we aim to study such price variations of antihypertensive drugs currently available in the Nepalese market.</p> <p><strong>Methods: </strong>We obtained the marked price of different antihypertensives manufactured in Nepal and India from various medicine stores within Chitwan from February to June 2021. Cost ratio (CR) and percentage cost variation (%CV) was calculated using Microsoft Office Excel-2019.</p> <p><strong>Results: </strong>We observed a high percentage of cost variation in Amlodipine 5mg (CR: 3.33 %CV: 233.33) among Nepali and Losartan 50mg (CR: 32.31 %CV: 3131.47) among Indian antihypertensives.</p> <p><strong>Conclusions: </strong>A wide percentage cost variation was observed among antihypertensive medications cur­rently available in the Nepalese market. Regulatory bodies could address the issue to ensure affordability of essential antihypertensive medications.</p> Sirisa Karki Gita Paudel Roshan Chaurasia Ashish Gautam Sanjay Raj Baral Karma Murti Bhurtyal Copyright (c) 2021 Sirisa Karki, Gita Paudel, Roshan Chaurasia, Ashish Gautam, Sanjay Raj Baral, Karma Murti Bhurtyal 2021-09-30 2021-09-30 11 3 41 44 Diabetic retinopahty: knowledge, attitude and practice <p><strong>Background</strong>: Diabetes Mellitus is a metabolic disorder with a multisystemic involvement such as heart, blood vessels, kidneys, nerves including eyes where, hyperglycemia causes loss of pericytes and thus damages retinal capillaries leading to diabetic retinopathy. The aim of this study was to access knowledge, attitude and practice pattern in diabetes patients residing in Chitwan and neighboring districts.</p> <p><strong>Methods: </strong>A community based cross-sectional study was carried out involving diabetes mellitus patients in three districts namely Chitwan, Nawalpur and Gorkha province along with patients who were referred to the hospital. Questionnaire were provided to the patients that accessing knowledge about the ocular complications, attitude and practice concerning diabetes and diabetic retinopathy. General systemic and ocular examinations were performed, including assessment of random blood sugar. The data was collected from March 2019 to June 2019. The collected data analyzed using Statistical Package for Social Studies (SPSS) version 11 (Armonk, IBM, USA).</p> <p><strong>Results: </strong>This study included 500 patients, ranging from 30-85years. Diabetes mellitus was diagnosed at an average age of 60.52±11.47 years (32-89 years) who were mostly being treated with an oral-hypoglycemic agents. About 95.2% of the patients in the screening camp and 96.4% from hospital were aware regarding the ocular complication in diabetes. Diabetic retinopathy prevalence was observed in 28% of the patients out of which 26% were from screening camp and 14.8% were from hospital, in whom bilateral ocular involvement were frequently observed.</p> <p><strong>Conclusions: </strong>The knowledge and attitude of the patient in our study were found to be adequate towards the diabetes and diabetic retinopathy. Nonetheless, this was not executed well in daily practice by the respondents.</p> Puspa Giri Ranjeet Sah Manisha Shrestha Raja Husain Munsuri Bishnu Mani Dhital Sudha Ranabhat Copyright (c) 2021 Puspa Giri, Ranjeet Sah, Manisha Shrestha, Raja Husain Munsuri, Bishnu Mani Dhital, Sudha Ranabhat 2021-09-30 2021-09-30 11 3 Assessment of postoperative pain and analgesic use in patients undergoing orthopedic surgery <p><strong>Background</strong>: Pain is an unpleasant sensation and occurs frequently in the post-operative period. Pain impairs treatment and recovery of patients and thus should be adequately managed. This study aimed to assess the intensity of pain in the post-operative patients undergoing orthopedic surgery and to evaluate the adequacy of the analgesics used.</p> <p><strong>Methods: </strong>This was a prospective observational study conducted at Chitwan Medical College, Department of Orthopedics from May to August 2019. Ninety-six patients who underwent orthopedic surgery were evaluated upto 72 hours after surgery and assessed for pain using interview, Visual Analogue Scale and medical record analysis. Type of analgesic used and its adequacy, using Pain Management Index, were also studied.</p> <p><strong>Results: </strong>There were 58 male and 38 female patients with age 18-79 years (mean 38.16 ± 16.34 years). 97.9% patients complained of pain in immediate, 91.7% in 1st and 82.3% in 2nd post-operative period with mean Visual Analogue Scale scores of 6.68, 3.74 and 2.68 respectively. Non-steroidal anti-inflammatory drug was the most frequently prescribed analgesic followed by its combination with opioid. Pain management was inadequate in immediate post-operative (61.5%), but there was significant improvement in 1st and 2nd post-operative period (inadequate Pain Management Index in 28.1% and 12.5% respectively).</p> <p><strong>Conclusions: </strong>Most patients experienced pain in the post-operative period, but the intensity decreased as the post-operative hours passed by. Pain management in the immediate post-operative period was inadequate in our study and therefore proper attention should be given to manage pain in the post-operative period.</p> Bishnu Dev Sharma Jyoti Sitaula Copyright (c) 2021 Bishnu Dev Sharma, Jyoti Sitaula 2021-09-30 2021-09-30 11 3 53 57 Knowledge on preconception care among bachelor level nursing students of selected campuses in Bagmati province <p><strong>Background</strong>: Preconception care is the provision of biomedical, behavioural and social health interventions to women and couples before pregnancy to improve the health status of mother, new-born and child. There is growing evidence that preconception care may have an important role in preventing short and long-term adverse health consequences for women and their offspring. So this study was conducted to assess knowledge on preconception care among bachelor-level nursing students.</p> <p><strong>Methods: </strong>A descriptive cross-sectional design with a purposive sampling technique was used to select 129 students from Constituents and affiliated Nursing campuses of Tribhuvan University in Bagmati Province. Data were collected over one month from 1st September to 27th September 2020. Knowledge on preconception care was evaluated through self-administered questionnaires. Analysis was done by using descriptive statistical tests.</p> <p><strong>Results: </strong>Among 129 respondents, 17.8% of respondents had adequate and 81.4% had a moderate level of knowledge on preconception care. The respondents had adequate levels of knowledge on teratogens and environmental toxins and inadequate on some of the very important issues such as proper time for preconception care, birth spacing, hygiene, and vaccines contraindicated during pregnancy.</p> <p><strong>Conclusions: </strong>Based on the findings, most of the respondents had a moderate level of knowledge but as a nurse to provide holistic care to the client and future mother they have to have an adequate level of knowledge to prevent adverse consequences of maternal and child health. Therefore, there seems to be a strong need to develop a simple guideline of preconception care and incorporate it into the nursing curriculum.</p> Padma Bhatta Kamala Upreti Bhagawoty Kalikotay Copyright (c) 2021 Padma Bhatta, Kamala Upreti, Bhagawoty Kalikotay 2021-09-30 2021-09-30 11 3 58 62 Study of cephalic index in newborns of Kavre region <p><strong>Background</strong>: The cephalometry of newborn within first few days is important for assessment of health status, neonatal death, growth and development. The objective of the study is to provide a baseline data for cephalic index and to observe sexual dimorphism.</p> <p><strong>Methods: </strong>The present study was cross sectional type. It consisted of 138(72 males, 66 females) healthy neonates born in Dhulikhel hospital via vaginal delivery. It was conducted from June 2019 to March 2020 after receiving ethical approval. The cephalic index was derived after measuring length and breadth of head. The collected data was entered in excel and analyzed with SPSS (16.0).</p> <p><strong>Results: </strong>The conducted study revealed the overall cephalic index as 86.51±4.95 and head circumference to be 336.05±13.87 mm. The values of head circumference and head length of males were higher than that of females. The head breadth of males was found to be significantly higher than that of females. The most common type of head type was hyperbrachycephalic with prevalence of 37.7% (40.3% males and 34.8% females).</p> <p><strong>Conclusions: </strong>This study concluded that the majority type of head was hyperbrachycephalic. The length, breadth and circumference of head values were higher in males than that of females.</p> Sunima Maskey Dil Islam Mansur Anish Joshi Pragya Shrestha Sheprala Shrestha Mukta Singh Bhandari Copyright (c) 2021 Sunima Maskey, Dil Islam MAnsur, Pragya Shrestha, Sheprala Shrestha, Mukta Singh Bhandari 2021-09-30 2021-09-30 11 3 63 67 Perinatal outcomes of singleton breech deliveries in a tertiary care centre in Nepal <p><strong>Background</strong>: Breech presentation has been associated with higher rates of perinatal morbidity irrespective of mode of delivery. The aim of this study was to determine the prevalence and perinatal outcomes of singleton breech deliveries at Chitwan Medical College, a tertiary level hospital in Nepal.</p> <p><strong>Methods: </strong>A retrospective review of records of all women who delivered at Chitwan Medical College with breech presentation from September 2018 to October 2020 was conducted. Information on demographic variables, obstetric characteristics and perinatal outcomes were obtained, recorded and analyzed.</p> <p><strong>Results: </strong>Out of 6712 cases of deliveries during the study period, 226 had breech presentation with prevalence of 3.37%. One hundred ninety-one (84.5%) of them had undergone Caesarean delivery with 125 (65.4%) emergency and 66 (34.6%) elective Caesarean delivery. More than two third (70.4%) of breech deliveries were term deliveries while 28.8% were preterm. There were 2 cases of still births and 1 neonatal death with Perinatal Mortality Rate of 13.27 per 1000 breech deliveries. Vaginal breech delivery was associated with higher perinatal mortality, low Apgar score and low birth weight. Caesarean breech delivery was associated with increased rates of Neonatal Intensive Care Unit admission.</p> <p><strong>Conclusions: </strong>The neonatal mortality and morbidity were higher with the vaginal breech deliveries. However further studies with larger sample size and greater statistical power is necessary to draw definitive conclusion.</p> Renuka Tamrakar Deekshanta Sitaula Basant Sharma Bandana Pokharel Dhan Khatri Sandip Pokharel Copyright (c) 2021 Renuka Tamrakar, Deekshanta Sitaula, Basant Sharma, Bandana Pokharel, Dhan Khatri, Sandip Pokharel 2021-09-30 2021-09-30 11 3 68 71 Socio-demographic factors associated with chhaupadi practice among adolescence girls of Mangalsen Municipality, Accham Nepal <p><strong>Background</strong>: Chhaupadi practice, which is characterized by banishment of women during menstruation from their usual residence due to supposed impurity. The Chhaupadi custom is also known as ‘chhue’or ‘bahirhunu’ in Dadeldhura,Baitadi and Darchula,as Chhaupadi in Acham, and as ‘chaukulla’or ‘chhaukudi’in Bajhang district.The aim of the study was to find out Socio demographic factors associated with Chhaupadi practices among adolescence girls of Mangalsen Municipality, Acham Nepal.</p> <p><strong>Methods: </strong>The community based descriptive cross-sectional study using face to face interview was carried out in Mangalsen Municipality, Acham Nepal. 221 adolescence girls (10-19) years were selected by simple random sampling. The total duration of data collection was one month from 2074/01/07 to 2074/02/08. Data were collected using self-designed semi structured questionnaire. Collected data were manually checked then entered into IBM SPSS version 20.0 for Window. We used Pearsons chi-square test is used to investigate the effect of Socio-demographic variable on Chhaupadi practices during last menstruation period of adolescent.</p> <p><strong>Results: </strong>Among 221 adolescent girls, there were 84.2 %(186) of the respondents were kept in Chhaupadi or slept at Chhau goth during entire last time menstrual period, Socio-demographic characteristics such as age (<strong><em>χ</em></strong><strong>2</strong>=8.997, 0.001), mother educational level(<strong><em>χ</em></strong><strong>2</strong>= 6.80, p=0.033), occupational status of respondent’s mother (<strong><em>χ</em></strong><strong>2</strong>=4.20, p=0.04) ,type of family(<strong><em>χ</em></strong><strong>2</strong>=5.20, p=0.022) were found to be significantly associated with Chhaupadi practice .</p> <p><strong>Conclusions: </strong>Majority of the adolescent girls are still practicing Chhaupadi during menstrual period. Chhaupadi practice continues to exits in community because of illetracy,traditional belief system.To abolish Chhaupadi practice awareness and education at community level is required.</p> Roshan Kumar Thapa Mamta Chhetri Amrita Paudel Subash Koirala Eak Narayan Poudel Kishor Adhikari Copyright (c) 2021 Roshan Kumar Thapa, Mamta Chhetri, Amrita Paudel, Subash Koirala, Eak Narayan Poudel, Kishor Adhikari 2021-09-30 2021-09-30 11 3 72 75 Knowledge, attitude and practice of abortion in slum area of Kathmandu <p><strong>Background</strong>: Abortion is legal up to 12 weeks’ gestation period in Nepal. Due to a lack of proper abortion services and socio cultural stigma, every year many women died due to abortion. The aim of this study was to asses the knowledge, attitude and practice of abortion in the residents of slum area of Kathmandu district.</p> <p><strong>Methods: </strong>The cross-sectional study was conducted in slum area of Kathmandu district from 20th December, 2020 to 15th January, 2021. The sample size was 255 and convenient sampling technique was used to select the participant aged above 15years. The collected data were enter in MS excel and analysis was performed using SPSS version 22.</p> <p><strong>Results: </strong>The prevalence of abortion was 25.27%.The level of knowledge was found significant with education status. Age, marital status, ethnicity were found significant with attitude of the respondents. Ten percentages of the female respondents had done unsafe abortion. The complications after abortion were the bleeding (54.3%), trauma (15.20%), loss of consciousness (13.0%) and abdominal pain (2.20%).</p> <p><strong>Conclusions: </strong>The level of knowledge of participants of the present study found to be satisfactory but attitude was less satisfactory with compared to the knowledge about the abortion.</p> Naresh Manandhar Milan Pokhrel Ramananda Yadav Satyadharm Komal Prasad Gautam Rishabh Raj Diksha Pokhrel Sunil Kumar Joshi Copyright (c) 2021 Naresh Manandhar, Milan Pokhrel, Ramananda Yadav, Satyadharm, Komal Prasad Gautam, Rishabh Raj, Diksha Pokhrel, Sunil Kumar Joshi 2021-09-30 2021-09-30 11 3 76 79 Pattern of ocular trauma and visual outcome in patients attending national referral eye hospital of Eritrea <p><strong>Background</strong>: Ocular trauma has been a significant disabling health problem and a leading cause of visual loss in lower-middle-income countries. These injuries have many diverse costs including human suffering, long-term disabilities, loss of productivity, and economic hardship. This study was aimed to describe the pattern of ocular trauma, its visual outcome, and the overall epidemiology of ocular trauma in all patients presenting to Berhan Eye Hospital, Asmara, Eritrea.</p> <p><strong>Methods: </strong>A prospective observational study was conducted on ocular trauma patients who presented to Berhan Eye Hospital for the open globe, closed globe, and peri-orbital trauma from September – November 2018 after ethical approval from the Ministry of Health, Eritrea. Data on demography, initial and final visual acuity, type of injury as well as its outcome were collected using U.S Eye Injury Registry checklist. The types of injuries were classified according to Birmingham Eye Trauma Terminology System (BETTS), SPSS Version 22 was used.</p> <p><strong>Results: </strong>Ocular trauma accounted for 1.94% of the total patients attending the outpatient department (OPD) and emergency during the studied period. Of the studied 280 participants, 218 (77.9%) patients were below 40 years of age. The male to female ratio was 2.4:1. Closed globe injuries accounted the highest 205 (73.21%) followed by the open globe injuries 75 (26.79%). Home and industrial premises were the main places where ocular injuries occurred in the participants.</p> <p><strong>Conclusions: </strong>Ocular trauma affects mainly the younger age group. Blunt objects trauma in the eye are more common in low resource settings. Ocular trauma is an important cause of monocular blindness which can be prevented with early intervention and health promotion.</p> Pradeep Bastola Amir Ibrahim Danait Michael Hermela Misghna Rut Russom Polina Dahal Femi Ibrahim Copyright (c) 2021 Pradeep Bastola, Amir Ibrahim, Danait Michael, Hermela Misghna, Rut Russom, Polina Dahal, Femi Ibrahim 2021-09-30 2021-09-30 11 3 80 87 Relationship between dental anxiety and pain perception during scaling in periodontally healthy subjects <p><strong>Background</strong>: Dental pain, anxiety and fear experience are the factors that discourage the demand for treatment. Dental treatment influences patients by causing stress and reminding them of unpleasant memories which often leads to the postponement of dental treatment deteriorating the periodontal health.Research showed that dental anxiety, fear and apprehensive anticipation of potential threats cause patients to cancel, miss, or arrive late for dental appointments. The aim of the study was to evaluate patients’ pain perception during scaling and its relationship with dental anxiety.</p> <p><strong>Methods: </strong>A cross sectional study was conducted in 200 dental patients from March 2021 to June 2021 at Kist Medical College and Hospital.Pain levels after scaling were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of seven questions, each with five possible answers. Data analysis was done with SPSS 21 using descriptive and inferential statistics.</p> <p><strong>Results: </strong>The mean VAS score for the entire group was 26.70±17.73 and for women and men were 28.68±17.70 and 24.75±17.64, respectively. The difference in mean VAS scores between women and men was statistically significant (p= 0.000). The mean anxiety score for the whole study population was 12.21±4.32.The questionnaire score was similar in women 13.46±4.55 and 10.99±3.71 in men (p =0.117).</p> <p><strong>Conclusions: </strong>An understanding of the presence of the anxiety and fear helps dentists to grasp what patients feel about dental treatment procedures and aid dentist efforts to enhance patients care.</p> Priti Shrestha Sonika Shakya Sijan Poudyal Bhageshwar Dhami Copyright (c) 2021 Priti Shrestha, Sonika Shakya, Sijan Poudyal, Bhageshwar Dhami 2021-09-30 2021-09-30 11 3 88 91 Motivating factors for choosing dentistry and plan after graduation <p><strong>Background</strong>: The knowledge of current motivation to choose dentistry and future plan of dental graduates is critical to health care systems and may result in major change for policies in dental education. This study aimed to assess the motivational factors that influenced students to choose dentistry as a profession and their future plan after graduation.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted among the 120 students who have cleared the final Bachelor of Dental Surgery (BDS) examination and were undergoing their mandatory internship program. The data was collected between January 2020 to April 2020. Data analysis was done using Statistical Prod­uct and Service Solution (SPSS) version 20 with descriptive and inferential statistics.</p> <p><strong>Results: </strong>The leading professional reason was the flexible working hour, 54.8% (n=57). Job stability, 50% (n=52), the desire to help people, 49% (n=51) and a desire to be associated with a health profession, 69.2% (n=72) were the primary reasons on economic, vocational and personal domains respectively. Around half of the participants 52% (n=54) have planned for further study after graduation. Similarly, 28.8% (n=30) of the participants have planned to live and work outside Kathmandu valley, 28.8% (n=30) were planning to live and work within Kathmandu valley.</p> <p><strong>Conclusions: </strong>This study found that the flexible working hour, job stability and desire to help people were the motivational factors for choosing dentistry. Majority have planned for further study. In future, only those from outside Kathmandu valley were willing to serve the people beyond the valley.</p> Sijan Poudyal Ram Sudhan Lamichhane Sudeep Acharya Amita Pradhan Copyright (c) 2021 Sijan Poudyal, Ram Sudhan Lamichhane, Sudeep Acharya, Amita Pradhan 2021-09-30 2021-09-30 11 3 92 96 Diagnosis and management of gallbladder perforation: a single-center experience <p><strong>Background</strong>: Gall bladder perforation is one of the uncommon serious complications of cholelithiasis and cholecystitis with high morbidity and mortality. Presentation of gall bladder perforation may vary from that of similar to acute calculus cholecystitis, perforation peritonitis, palpable gall bladder mass to gall stone ileus. Here, we present our experience on the diagnosis and management of the case of gall bladder perforation.</p> <p><strong>Methods: </strong>This is the retrospective review of the records of 24 patients who received medical and/or surgical treatment with the diagnosis of gall bladder perforation at Chitwan Medical College from January 2016 to December 2020. All the patients with suspicion of gall bladder perforation underwent contrast enhanced CT scan before an operation or prior intervention.The parameters including age, gender, type of perforation, comorbidities, symptoms, diagnostic procedures, treatment modalities, morbidity, and mortality were evaluated.</p> <p><strong>Results: </strong>A total of 24 patients were included in the study during the study period. Among them 62.5% (n=15) were male and 37.5% (n=9) were female.The median age of presentation was 69 years. One patient (4.1%) had type I, 87.5% (n= 21) had type II, and 8.3 % (n=2) had type III gall bladder perforation. CT scan visualizes the defect in gall bladder wall and identifies perforation in all cases. Operative management was done in 12.5% (n=3) patients and percutaneous drainage of gallbladder was done in 87.5% (n=21). The comorbid disease was present in 83.3 % (n=20) of the cases. The median duration of hospital stay was 7 days and there was no mortality.</p> <p><strong>Conclusions: </strong>Gall bladder perforation is commonly seen in patients with acute cholecystitis and associated comorbidities. Type II gall bladder perforation is the most common type. Contrast-enhanced CT has an important role in diagnosing gallbladder perforation. Early suspicion, diagnosis, and appropriate management are of crucial importance for a better outcome in patients with gall bladder perforation.</p> Abhishek Bhattarai Pragya Devkota Anup Shrestha Keshmaya Gurung Kishor Kumar Tamrakar Harish Chandra Neupane Copyright (c) 2021 Abhishek Bhattarai, Pragya Devkota, Anup Shrestha, Keshmaya Gurung, Kishor Kumar Tamrakar, Harish Chandra Neupane 2021-09-30 2021-09-30 11 3 97 100 Management of traumatized anterior teeth at a tertiary care center of Nepal <p><strong>Background</strong>: Immediate treatment of an injured tooth is the most significant factor for preserving pulp vitality. Treatment provided immediately after traumatic dental injury significantly improves the prognosis of a traumatized tooth by reducing the risk of complications. Similarly, proper treat­ment can lead to satisfactory outcomes. The objective of this study was to evaluate the type of treatments provided to the patients with dental trauma and the time elapsed between dental injury and arrival for treatment.</p> <p><strong>Methods: </strong>A retrospective study was conducted including 170 patients (128 males and 42 females) who received treatment for traumatic dental injury during a period between January 2016 and December 2019. The time elapsed between dental trauma and treatment, and the clinical treatments provided were recorded form a review of past records. Data analysis was performed using descriptive statistical methods.</p> <p><strong>Results: </strong>The time elapsed between trauma and treatment was found to range from 1 to 75 hours. (Aver­age time 14.7 hours). An early arrival for treatment of dental trauma within 24 hours was observed among most of the patients (76.46%) in this study. The most commonly provided treatment was composite resin restoration (38.78%). Likewise, the second most frequently provided treatment was root canal treatment (29.08%). Overall splinting was provided in 44 teeth (12.18%), while repositioning along with splinting was performed in 43 teeth (11.91%).</p> <p><strong>Conclusions: </strong>On the basis of the results of this study it can be concluded that, most of the patients with traumatic dental injuries arrived for treatment early and restoration was the most common treatment provided followed by root canal treatment.</p> Sanjeeb Chaudhary Harender Singh Archana Gharti Bhawana Adhikari Copyright (c) 2021 Sanjeeb Chaudhary, Harender Singh, Archana Gharti, Bhawana Adhikari 2021-09-30 2021-09-30 11 3 101 106 Epidemiological, clinical pattern and outcome of first wave of SARS-CoV-2 patients in Bagmati province of Nepal <p><strong>Background</strong>: The first wave of COVID 19 pandemic was among all age group with different presentations and outcome. This study done was to explore the social demographics, clinical characteristics, comorbidities and outcome of SARS-CoV-2 patients in Bagmati province.</p> <p><strong>Methods: </strong>A retrospective study was done among the first wave of SARS-CoV-2 positive patients registered during the first wave in provincial Health Emergency Operation Center (PHEOC), Bagmati, Nepal. Data was collected from 14th April 2020 to 15th October 2020. Demographic and clinical characteristics, comorbidities, isolation centers and outcome of Bagmati province were analyzed and described.</p> <p><strong>Results: </strong>Among the 58916 cases; 37045 (62.87%) were male 21871 (37.12%) were female, 4434 (7.52%) cases were below 18 years while 54482 (92.47%) were of older than 18 years. Median age was 36.56 years (IQR 1 day to 108 years). There were 1507 (2.55%) cases having co morbidities while 57409 (97.44%) did not have. There were 48734 (82.71%) asymptomatic cases and 10182 (17.28%) symptomatic. There were cases having fever 2665 (26.17%), loss of taste 2130 (20.91%), loss of smell 2097 (20.59%), cough 1330 (13.06%) and common cold 895 (8.79%) with involvement of respiratory system, gastroenterology and central nervous system. Home and intuitional isolated cases were 55227 (93.73%) and 3689 (6.26%) respectively. Four hundred eighty-seven (6.04%) had travel history within 15 days and 242 (0.41%) died.</p> <p><strong>Conclusions: </strong>In the first wave of the COVID pandemic, most cases were asymptomatic while systemic involvement of CNS; respiratory, gastrointestinal symptoms were common presentation. Mostly patient remained in home isolation, few cases had co morbidity and had good outcome in total.</p> Santosh Adhikari Ramesh Adhikari Himanshu V Ram Hari Chapagain Bina Prajapati Hari Bahadur Khadka Raj Kumar Dangal Purusotam Shedain Rasmi Tamang Copyright (c) 2021 Santosh Adhikari, Ramesh Adhikari, Himanshu V, Ram Hari Chapagain, Bina Prajapati, Hari Bahadur Khadka, Raj Kumar Dangal, Purusotam Shedain, Rasmi Tamang 2021-09-30 2021-09-30 11 3 107 110 Learning anatomy during COVID pandemic: a study from Universal College of Medical Science <p><strong>Background</strong>: Pandemic plays a pivotal role in reshaping history of mankind. Forced disruption in anatomy education system has compelled us to start all our classes online. Although the COVID‐19 pandemic is likely to be the first which current anatomy students are affected by, lessons and experiences can be drawn from the present crises to help us adapt and reform anatomy. The aim of this study was to evaluate medical students’ experience about learning anatomy online during covid pandemic.</p> <p><strong>Methods: </strong>This was a descriptive cross-sectional study carried out at universal college of medical science among first and second year MBBS and BDS students from 1st June 2020 to 30th August 2020. A semi-structured, validated, feedback questionnaire was emailed to a total of 255 students, and the filled up response was received from 211 students. The data were collected and descriptive analysis was done using SPSS ver. 22.</p> <p><strong>Results: </strong>Almost 178(84.36%) of students were understanding anatomy class through online lectures, Majority of students 196 (92.89%) of students consider dissection/cadavers or models as an integral part for learning anatomy. similarly, more than three fourth 168(79.62%) of students were in favor of combination of online class with traditional class for better understanding of anatomy discipline.</p> <p><strong>Conclusions: </strong>Online anatomy class was considered effective during crisis but students were suggesting blending of online class with traditional class. Lesson should be learned from current pandemic and explore anatomy education system beyond traditional. We highly recommend development of new anatomy blended curriculum for better understanding of subject.</p> Nitasha Sharma Ruku Pandit Copyright (c) 2021 Nitasha Sharma, Ruku Pandit 2021-09-30 2021-09-30 11 3 111 114 Knowledge and barriers of incident report among nurses in teaching hospital, Bharatpur <p><strong>Background</strong>: An incident report is a formal recording of the facts related to a workplace accident, injury or near miss. So, incident should be reported properly and immediately in effective way which would lead appropriate management and prevention of incident. This study aimed to assess the knowledge and barriers of incident reports among nurses.</p> <p><strong>Methods: </strong>A cross-sectional study design was used among nurses working in teaching hospitals. A simple random sampling technique was used to select 208 nurses and data was collected by using self-administered questionnaire from June 18, 2019 to July 18, 2019. Data was analyzed in SPSS version 20 using descriptive statistics and inferential statistics.</p> <p><strong>Results: </strong>This study revealed that 73.1% of respondents had poor knowledge on incident report. Whereas common barrier identified by respondents were work complexity (40.4%), fear of blamed (59.1%), lack of protocol (50.0%) and inadequate reporting system (42.3%). Nurses level of knowledge was statistically significant with level of education (p=0.001), professional designation (p=0.001), available guideline (p=0.004) and available reporting format (p=0.014)</p> <p><strong>Conclusions: </strong>This finding concluded that nurse’s knowledge is limited on incident reports and number of barrier of incident reporting had been identified. With this information nurses knowledge should be upgraded by providing in service education on incident report and availability of protocol along this hospital administrator should support, ensure anonymity and create a strong safety culture within hospital which will reinforce staff to report incident immediately thus to reduce the reoccurrence of errors and enhance patient’s safety.</p> Sajina Lama Dina Khanal Copyright (c) 2021 Sajina Lama, Dina Khanal 2021-09-30 2021-09-30 11 3 115 118 Clinical efficacy and safety between continuous rotary and reciprocating root canal instrumentation systems <p><strong>Background</strong>: The single file reciprocating system prepares the canal quickly with a better centric ability and has increased resistance to cyclic fatigue compared to the continuous rotary file system. However, the former file system was associated with more postoperative pain than the latter. The goal of the present study was to evaluate and compare the clinical efficacy and safety between continuous rotary and reciprocating instrumentation systems.</p> <p><strong>Methods: </strong>Fifty patients who fulfilled specific inclusion criteria were assigned into 2 groups according to the root canal instrumentation technique used, ProTaper Gold and WaveOne Gold. Endodontic treatment was performed in a single visit. Patients were instructed to rate the intensity of postoperative pain on Visual Analog Scale and to record the quantity of prescribed analgesic medication taken after 24 hours, 48 hours, 72 hours, and 7 days. Time of root canal preparation, duration of pain, and incidence of procedural errors such as ledging, transportation, root perforation, and instrument separation were recorded. The data was collected from October 2018 to September 2019. SPSS version 24 was used for data analysis.</p> <p><strong>Results: </strong>This study revealed no statistically significant difference between instrumentation groups with relevance to postoperative pain and analgesic medication intake (P &gt; 0.05). Canal preparation time was significantly shorter in reciprocating group compared to rotary group (P &lt; 0.001). Further, the incidence of procedural errors in both instrumentation group was found statistically insignificant (P &gt; 0.05).</p> <p><strong>Conclusions: </strong>Continuous rotary and reciprocating systems were both found to have similar clinical efficacy and safety and hence can be used to instrument the root canals.</p> Govind Kumar Chaudhary Md. Shamsul Alam Mozammal Hossain Copyright (c) 2021 Govind Kumar Chaudhary, Md. Shamsul Alam, Mozammal Hossain 2021-09-30 2021-09-30 11 3 119 125 Diagnostic quandary with Laugier-Hunziker syndrome <p>Laugier-Hunziker syndrome being a rare pigmentation disorder chiefly involving lips and nails has<br>so far been coincidentally diagnosed. In Nepal, Laugier-Hunziker syndrome has not been reviewed<br>very well, and no case has been reported in the literature till date. To the best of our knowledge,<br>the current report is the only one in the Nepalese scientific community but addressing the age of<br>the patient it stands with a diagnostic quandary.</p> Neha Mishra Sourav Kumar Rout Copyright (c) 2021 Neha Mishra, Sourav Kumar Rout 2021-09-30 2021-09-30 11 3 132 134 Dieulafoy’s lesion of jejunum presenting as an obscure gastrointestinal bleeding: a case report <p>Obscure gastrointestinal bleeding has been designated as bleeding of unknown origin that persist<br>or recurs after a negative initial or primary endoscopy (colonoscopy and upper endoscopy). We<br>present a case of 16 years old male who was admitted at our hospital with presentation of black<br>tarry hard foul-smelling stool associated with weakness, dizziness and loss of consciousness for<br>10-15 minutes. Physical examination showing pallor. Upper GI Endoscopy, colonoscopy and double<br>balloon Enteroscopy (DBE) failed to find out the cause of bleeding whereas, CT angiography shows<br>a prominent submucosal vessel with blush of contrast enhancement seen at mid-jejunum and<br>suggestive of a Dieulafoy’s lesion. As the lesion was not identified properly during both anterograde<br>and retrograde Double Balloon Enteroscopy we decided to go for the conservative management<br>and treated the patient on close monitoring.</p> Yeshika Thapa Sagar Poudyal Copyright (c) 2021 Yeshika Thapa, Sagar Poudyal 2021-09-30 2021-09-30 11 3 135 137 Orthodontic extrusion: an aid to salvage subgingivally fractured incisor <p>Traumatic injuries to permanent incisors not only cause esthetic but functional as well as<br>psychological problems to patients. This case report describes treatment approach of a<br>subgingivally fractured permanent maxillary central incisor. Conventional root canal treatment<br>followed by orthodontic extrusion was performed for the fractured tooth to bring the fracture<br>margins to supragingival level. The tooth was then restored with fiber post and core.</p> Bhawana Adhikari Bibek Khanal Chetna Arora Copyright (c) 2021 Bhawana Adhikari, Bibek Khanal, Chetna Arora 2021-09-30 2021-09-30 11 3 138 140 Heart failure with low ejection fraction as a presentation of severe primary adrenal insufficiency <p>Addison’s disease or primary adrenal insufficiency is a condition where there is decreased<br>production of glucocorticoid and mineralocorticoid from adrenal cortex and it’s prevalance is<br>around 100- 140 cases per millions in western societies. It has wide range of clinical features and is<br>a serious condition. If diagnosed and treated in time, patient’s condition can improve significantly.<br>Here we present 37 years old female who presented with wide range of vague clinical features<br>and was in shock and on investigation, her serum sodium was low and potassium level was high.<br>With usual treatment of shock, patient condition didn’t improve. So, echocardiography was done<br>which showed global Left Ventricular wall hypokinesia with left ventrical ejection fraction of 25-<br>30%. She was also taking treatment for hypothyroidism. Endocrinology consultation was done<br>for her hypothyroidism, hyponatremia and possible adrenal crisis. Serum Cortisol was sent which<br>was found low. With treatment with glucocorticoids and mineralcorticoids, patient improved<br>significantly. She recovered from shock, her serum sodium and potassium became normal and<br>after one month, left ventricular ejection fraction improved to 50%. So, with timely diagnosis and<br>proper treatment, Addison’s disease can be treated easily.</p> Saurav Khatiwada Bishnu Singh Laxman Mandal Rahul Mittal Rupesh Jaiswal Copyright (c) 2021 Saurav Khatiwada, Bishnu Singh, Laxman Mandal, Rahul Mittal, Rupesh Jaiswal 2021-09-30 2021-09-30 11 3 141 144 Vaginal extrusion of huge decidual cast: an exceptional case report <p>Infrequent, irregularly irregular delayed menstrual period accompanied by heavy bleeding<br>prolonged for weeks to months was treated with oral norethisterone 5mg tablet in 5mg – 30mg<br>daily divided dose resulted in painful vaginal extrusion of huge fleshy mass (10 x7 x 5 cm) retaining<br>the shape uterus histopathologically confirmed as decidual cast, a rare, as well as incomparable<br>case, is described in an unmarried nulligravida in late twenty’s to alert the association of<br>progesterone to membranous dysmenorrhea.<br>Everyone under the hormonal treatment for menstrual disorders must be educated and made<br>aware of the underlying dreadful possibility of painful vaginal expulsion of decidual cast ascribed<br>to membranous dysmenorrhea to cope or overcome the fright.</p> Apariharya Rana Manisha Bhardwaj Sarmila Prajapati Ashma Rana Copyright (c) 2021 Apariharya Rana, Manisha Bhardwaj, Sarmila Prajapati, Ashma Rana 2021-09-30 2021-09-30 11 3 145 147 Distal tibia interosseous osteochondroma with fibula deformity <p>Osteochondroma, one of the commonest bone tumors, is a cartilage capped exostosis. It occurs<br>commonly in rapidly growing ends of long bones. It’s rare in slowly growing regions of long bones.<br>Osteochondroma present in distal tibial interosseous border causing fibular deformity is very<br>uncommon. Osteochondroma is usually managed conservatively till the age of skeletal maturity,<br>but distal tibial osteochondromas are managed surgically to prevent deformity, impending fibula<br>fracture, ankle pain, syndesmotic injury irrespective of skeletal maturity. It is a case report of an<br>18-year-old male with gradually increasing, painless mass at the distal leg for 6 years, increasing<br>bowing deformity since 2 years with no functional limitations. Clinical and radiological findings<br>were consistent with distal tibial osteochondroma with deformity of the adjoining fibula. Exostosis<br>was excised successfully leaving a thin deformed distal fibula. The result was painless, stable,<br>and non-progressive residual ankle deformity. Histopathology confirmed the diagnosis with no<br>malignant transformation.</p> Sunil Panta Shrawan Kumar Thapa Krishna Prasad Paudel Copyright (c) 2021 Sunil Panta, Shrawan Kumar Thapa, Krishna Prasad Paudel 2021-09-30 2021-09-30 11 3 148 150