Journal of College of Medical Sciences-Nepal 2022-03-31T00:00:00+00:00 Dr. Dipendra Khatiwada Open Journal Systems <p>Official journal of the College of Medical Sciences, Bharatpur, Nepal. Full text articles available. Also available at <a title="JCMS-Nepal" href="" target="_blank" rel="noopener"></a>.</p> <p>Journal of College of Medical Sciences-Nepal is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> 2-Deoxy D-Glucose in COVID-19: Current Research Trends 2021-06-08T04:14:11+00:00 Jared Robinson Indrajit Banerjee Alexandra Leclézio <p>2-Deoxy D- glucose is a novel drug. It is an analogue of glucose which has innate therapeutic uses due to both its antiviral properties as well as its anti-neoplastic action. The SARS-CoV-2 virus binds to the host cell via the (S2) spike glycoprotein. Once viral entry has been gained into the host cell the virus hijacks the host’s intracellular machinery via 2 factors; 3CLpro<br />and NSP15. It has been shown through the use of Toxicity estimation software as well as via Molinspiration that 2-Deoxy D- glucose and its aforementioned isomers can effectively bind with 3CLpro and NSP15 and intern thus immobilize the SARS-CoV-2 virus via the incapacitation of its viral receptors. On a molecular level the 2-Deoxy D- glucose derivatives produce a H bond with the glutamine AA residues of the SARS-CoV-2 (S2) spike, as well form a Hydrogen bond with the 2 Deoxy D-glucose and proline residues of the SARS-CoV-2 protease. It is thus evident via both molecular and in silico studies that 2 Deoxy D- glucose and its isomers have the ability to offer further protection and or have imperative diminution capabilities in the treatment of patients with the COVID-19 infection. 2-Deoxy D- glucose has shown promising results in clinical trials and has produced faster recovery in hospitalized patients and abridged additional oxygen dependence in COVID-19 patients in various states across India. The scope and potential for the use of 2-Deoxy D- glucose in the treatment of COVID-19 is evident. It is therefore of great importance that further in vivo studies are conducted with 2-Deoxy D-glucose in order to expedite the process of bringing this potentially lifesaving drug to market. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Jared Robinson, Indrajit Banerjee, Alexandra Leclézio Impact of Dysmenorrhea on Female Adolescents 2021-11-30T08:22:37+00:00 Poonam Karmacharya Anshu Bhattarai Indu Tiwari Surjit Singh <p><strong>Introduction</strong><br />Dysmenorrhea is a common condition that usually presents itself with cramps or a dull ache, mostly in the abdominal region. Alongside the cramps, it is also common to suffer from other symptoms such as nausea, diarrhoea, constipation, mood swings and headaches. Dysmenorrhea has been considered a leading cause of occupational and college absenteeism among women, yet little is known about its actual impact. The objective of this study is to understand the impact of<br />dysmenorrhea in the young female medical students.</p> <p><strong>Methods</strong><br />A cross-sectional study was carried out in 100 undergraduate students of Manipal college of Medical Sciences, Pokhara, Nepal. Standardized Self-reporting questionnaires were used to obtain relevant data. Data entry and analysis were done in SPSS 20. </p> <p><strong>Results</strong><br />Out of 100 females, Majority of girls, 84 out of 100 reported different grades of dysmenorrhea. The study also showed strong association of dysmenorrhea with the family history and the severity of dysmenorrhea was highly associated with college absenteeism and regularity of the cycle. (p-value&lt;=0.005). Other symptoms like stomach cramp, anxiety, irritability, difficult in concentration and insomnia were also significantly associated with dysmenorrhea (p&lt;0.005) while stress was strongly associated with the dysmenorrhea. (p&lt;0.000). However, Backaches, painful breast, nausea, skin disorders, appetite and forgetfulness were not associated with dysmenorrhea (p&gt;0.005).</p> <p><strong>Conclusions</strong><br />Dysmenorrhea is found to be highly prevalent and has a negative impact on physical, social and academic activities of medical female students. The effect of dysmenorrhea is very wide, therefore managing the condition is very important.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Poonam karmacharya, Anshu, Indu, Surjit Singh Mortality and Morbidity Patterns of COVID-19 Patients at a Tertiary Health Care Centre of Nepal 2022-02-11T10:39:02+00:00 Prerna Bansal Pallavi Koirala Hari Prasad Upadhyay Rashmi Maharjan Satish Kumar Sah Ayasha Shrestha <p><strong>Introduction</strong><br />COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) associated with substantial morbidity and mortality putting the entire health system under strain. This study aims to assess the sociodemographic and morbidity factors of COVID-19 patients and their association with COVID-19 mortality.</p> <p><strong>Methods</strong><br />It was an analytical cross-sectional hospital based study in a single tertiary level health care centre in Central part of Nepal. Total 425 COVID-19 patients who were treated at the tertiary health care centre from August 1st 2020 to December 31st 2020 were included in the research.</p> <p><strong>Results</strong><br />Out of 425 patients, 230 (54.1%) were male and 195 (45.9%) were female. The mean age group of patients was 50.01±20.03 years, ranging from 7 days to 91 years of age. Total 262 (61.6%) patients had some type of comorbidity. The deaths were more in advancing age, in males and in patients residing in urban areas. Out of total deaths, 41(85.4%) patients had presence of some type of comorbidity. Age, place of residence, co-morbidities, length of hospital stay and place of treatment of patients showed a significant association with COVID-19 mortality with p-value &lt;0.05.</p> <p><strong>Conclusions</strong><br />COVID-19 mortality risk increases with advancing age and comorbidity. The global morbidity and mortality of the disease can only decline with the combined effect of preventive measures and health promotion of high risk groups especially those with morbidities like diabetes, hypertension and respiratory diseases.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Prerna Bansal, Dr. Pallavi Koirala, Mr. Hari Prasad Upadhyay, Dr. Rashmi Maharjan, Dr. Satish Kumar Sah , Dr. Ayasha Shrestha Functional Outcome and Quality of Life After Surgical Fixation of Tibial Plateau Fracture in a Tertiary Care Center of Nepal 2022-03-05T09:51:57+00:00 Jagadish Thapa Bikash Parajuli Rohit Shrestha Sabik Raj Kayastha Nabaraj Acharya Sudarshan Pandey <p><strong>Introduction</strong><br />Functional outcome and quality of life (QoL) of patients will change following tibial plateau fracture fixation. There are limited studies evaluating functional and radiological outcomes following tibial plateau fixation in Nepal, and none has evaluated QoL. We aim to evaluate functional outcome and QoL in patients with tibial plateau fracture with a follow up period of more than two years.</p> <p><strong>Methods</strong><br />This was a cross sectional, observational study done at Dhulikhel Hospital, from August 2021 to January 2022. Western Ontario and McMaster Universities Arthritis Index (WOMAC) functional outcome and World Health Organization QoL-8 (WHOQoL-8) questionnaire were filled by patients operated for tibial plateau fracture from 2011 to 2019. Compound fractures, untraceable patients, and those managed with casts were excluded from the study.</p> <p><strong>Results</strong><br />There were 121 patients (male: female = 2.3:1) with a mean age of 37.1 years. Road traffic accidents (44.6%) were the most common mode of injury, and Schatzker type IV (30.6%) was the most common type of fracture. The average WOMAC score was 13.05±12.1 and the average WHOQoL-8 score was 30.24±4.1. The average WOMAC score in high-energy and low energy trauma patients were 17.07±12.29 and 8.21±10 respectively. The average WHOQoL-8 in high energy and low energy<br />trauma patients were 29.28±3.59 and 31.38±4.38 respectively.</p> <p><strong>Conclusions</strong><br />Surgical reduction and stable internal fixation of tibial plateau fractures with long term follow up has a good functional outcome and quality of life. High energy trauma is associated with poor functional outcome and quality of life.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Jagadish Thapa, Bikash Parajuli, Rohit Shrestha, Sabik Raj Kayastha, Nabaraj Acharya, Sudarshan Pandey Knowledge and Utilization of Postnatal Care Services among Mothers Residing in a Community of Jhapa District 2021-07-09T13:39:52+00:00 Menuka Dahal Sabitra Subedi Punam Kumari Mandal Suvekshya Silwal <p><strong>Introduction</strong><br />Postnatal care is the most important maternal health care intervention for prevention of impairments, disabilities and also reduction of maternal mortality. However, mothers often only seek postnatal care in the event of complications after birth. The aim of this study is to assess the knowledge and utilization of postnatal care services among mothers in a community at Buddhashanti, Jhapa.</p> <p><strong>Methods</strong><br />A descriptive cross sectional research design was adopted. Sample was taken from married women in the reproductive age group, residing in Buddhashanti rural municipality of Jhapa District, who had a live baby less than 24 months old, attending immunization outreach clinics. Non-probability purposive sampling was used to collect data. The sample size was 104. Data were collected using a self-developed, semi-structured questionnaire through interview. Descriptive statistics such as<br />frequency mean and standard deviation were used in the analysis of collected data. Association between dependent and independent variables was measured by using the Chi- square test.</p> <p><strong>Results</strong><br />The finding of the study revealed that less than half (32.7%) of the mothers had good knowledge on postnatal care. Similarly, the majority (87.5%)of mothers had not utilized postnatal care services. Study revealed that level of knowledge had significant association with ethnicity, educational level of respondent and number of ANC visits with p- value 0.002, 0.038, 0.040 respectively. Furthermore, utilization of postnatal care had association with occupation of respondent and type<br />of delivery (p- value&lt;0.05).</p> <p><strong>Conclusions</strong><br />This study showed that respondents had poor knowledge on postnatal care and the majority of respondents had not utilized postnatal care services. Study revealed that ethnicity; educational level of respondent and no. of ANC visit had association with level of knowledge. Furthermore, occupation of respondent and type of delivery had association with utilization of postnatal care.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Menuka Dahal, Sabitra Subedi, Punam Kumari Mandal, Suvekshya Silwal Knowledge and Practice of Documentation Techniques among Staff Nurses 2022-02-21T09:49:07+00:00 Nirmala Gurung <p><strong>Introduction</strong><br />Nurses are the backbone of health care systems. They are have to deal with documentation process regularly.There may be good knowledge and poor practice about documentation.The objective of the study is to find out knowledge and practice of documentation among staff nurses.</p> <p><strong>Methods</strong><br />A descriptive cross-sectional study was conducted on staff nurses of a College of Medical Sciences- Teaching hospital between, after taking ethical approval from the Institutional Review Committee. A purposive sampling method was used and sample size was calculated to be 200. A structured questionnaire was used to collect the demographic details and knowledge and practice of documentation. Data was analyzed using statistical package for the social sciences version 20.<br />Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data.</p> <p><strong>Results</strong><br />The knowledge of documentation was seen adequate among 150(75%) staff nurses. The practice of documentation was seen poor 188(94%) among staff nurses. </p> <p><strong>Conclusions</strong><br />The prevalence of adequate knowledge and poor practice is more in our study which is similar to other studies done in similar settings. Therefore, there is need of inservice education among staff nurses, thereby reaching a better patient care and safeguarding them from legal issues. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Nirmala Gurung Morphometric Analysis of Odontoid in Nepalese Individuals of Eastern Nepal 2021-10-28T00:44:37+00:00 Subash Chandra Jha Satendra Raut <p><strong>Introduction</strong><br />There is ethnic variation in the morphometry of odontoid and it is always mandatory to know the anatomy of odontoid before surgery to achieve the success of the surgery either with 1 or 2 screws fixation. There is no literature on the morphometry of odontoids in the Nepalese population.</p> <p><strong>Methods</strong><br />Two hundred and ten consecutive patients whose CT-scan of the head or cervical spine were done without any evidence of cervical injury or fracture were included in the study. Morphometric measurements were done using Horos software in axial, coronal, and sagittal planes.</p> <p><strong>Results</strong><br />The mean age was 42.32 ± 16.16 (range 17-76) years including 104 males and 106 females. The mean screw length was 36.52 ± 3.14 mm and the screw insertion angle in relation to the inferior endplate of C2 vertebrae is 55.66 ± 4.74 degrees. The anteroposterior diameter of the odontoid was significantly more than the transverse diameter at the base and at the waist of the odontoid. A total of 97 (46.1%) individuals had their transverse waist diameter between 7.4 -9 mm and 31 (14.76%)<br />had their dimension below 7.4 mm.</p> <p><strong>Conclusions</strong><br />Almost 2/3rd of the Nepalese population has an inadequate diameter of odontoid for two 3.5 mm screws since the transverse waist diameter is less than 9 mm. Hence, either two 2.7 mm screws or a single 4.5 mm screw fixation should be considered in the majority of the cases but only after preoperative CT-scan-based morphometric measurement.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Subash Chandra Jha, Satendra Raut Clinicomycological Study of Superficial Mycoses: A Changing Trend of Increasing Non-dermatophyte Mold Infection 2021-11-30T06:24:13+00:00 Hari Pathave Manjulata Dash Gitanjali Sarangi Prasenjeet Mohanty Diptiranjani Bisoyi <p><strong>Introduction</strong><br />Superficial mycoses refer to the diseases of skin and its appendages caused by fungi. The geographical distribution of fungi may change from time to time; hence this study was planned. To find out the prevalence of different clinical types of dermatomycoses and dermatomycotic mold infections and their etiological agents.</p> <p><strong>Methods</strong><br />A total of 560 clinically diagnosed cases of superficial mycoses visiting tertiary care centre for a period of two years were included in the study. Specimens like skin scrapping, nail clipping, hair were collected and subjected to KOH mount and culture. Identification of species was done by macroscopic examination of culture, tease mount, slide culture and Germ tube test. Wood’s lamp examination was also performed.</p> <p><strong>Results</strong><br />Superficial mycoses were more common in the age group of 21-30 years (33.22%) and in males (71.96%). Tinea corporis 163/469 (34.75%) was the commonest clinical type in dermatophytosis followed by tinea cruris 145/469 (30.92%). 53.04% cases were positive by direct microscopy and 62.86% cases showed culture positive. Out of 352 culture positive cases, dermatophytes were isolated in 80.11% followed by yeasts (15.91%) and non-dermatophyte molds (NDM) (3.98%). The most common isolate among dermtophytosis was Trichophyton rubrum 156/282 (55.32%). An Aspergillus spp., Hortaea werneckii,<br />Cladophialophora carrionii and Exophiala jeanselmei were some of NDM.</p> <p><strong>Conclusions</strong><br />It was found that along with dermatophytes, non-dermatophytic fungi are also emerging as an important cause of superficial mycoses. A rare NDM like Cladophialophora carrionii and Exophiala jeanselmei can have possible causative role in the tinea corporis. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Dr. Hari Pathave, Dr. Manjulata Dash, Dr. Gitanjali Sarangi, Dr. Prasenjeet Mohanty, Dr. Diptiranjani Bisoyi Trend and Usage of Internet for Self Directed Learning in Phase I MBBS Students in an Urban Medical College: Observations and Challenges 2021-12-31T08:40:00+00:00 Swati Bhattacharyya Suparna Roy Kaushik Kar Anindya Dasgupta <p><strong>Introduction</strong><br />GMR 2019 have suggested fixed hours of self-directed learning (SDL) for all subjects for helping the students to develop their learning skills and sense of responsibility for a better learning in future. Presently, the trend of SDL is becoming more e learning centric in comparison to use of text books with its consequent advantages and disadvantages. The present study aimed to analyze the challenges associated with this trend in the phase 1 MBBS students.</p> <p><strong>Methods</strong><br />In an interventional educative study 203 phase 1 students from an urban medical college were assessed for an SDL based project on clinical aspects of the urea cycle at the end of the topic ammonia metabolism in Department of Biochemistry. Output from students were analysed for their trend for using resource materials, selection of relevant materials and originality of their inputs during the SDL process. Data obtained were analysed for their percentage distribution and<br />difference of mean values as applicable.</p> <p><strong>Results </strong><br />Out of 197 students who submitted their SDL projects in completed form, 61% students used internet information only, 20% used books only while 19% used both their resource materials. 32% of them could not use right key words for search and produced irrelevant materials in their topic. About 58% adopted copy and paste process without any change. Interestingly, the marks obtained by text book users were significantly higher than those using e resource materials.</p> <p><strong>Conclusions</strong><br />The present study reveals that in spite of having a higher inclination to use e learning resources most of the students are yet to coordinate between their study topic &amp; internet information. Moreover, the trend for copying without comprehension was found to be significantly higher among e learners. Hence, the investigators suggest that for proper use of SDL, guidance by expert faculties regarding how to search internet properly using appropriate keywords and how to comprehend the core information of the e-resources into their own language are necessary to make it a successful component of CBME. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Professor Swati Bhattacharyya, Dr. Suparna Roy, Dr. Kaushik Kar, Professor Anindya Dasgupta Spectrum of Central Nervous System Tumours at Tertiary Care Centre in Nepal 2021-10-31T09:52:13+00:00 Pramod Chaudhary Sunil Munakomi Narendera Joshi Babita Khanal Prakash Kafle <p><strong>Introduction</strong><br />Most of the Central Nervous System tumors are benign. There is increase in the incidence in recent days which might be due to improved diagnosis with advancement in the ancillary studies. This study aims to provide a single centre histopathological spectrum of tumor of CNS.</p> <p><strong>Methods</strong><br />This is a retrospective cross-sectional study of 138 cases of CNS tumors managed surgically in the department of neurosurgery from 2017 to 2020.All the histological subtypes and grading were reviewed. Data of the study population were analysed using SPSS version 25 and Microsoft excel. All the patients were classified as per the 2007 World Health Organization classification of central nervous system tumors.</p> <p><strong>Results</strong><br />A total of 138 cases were analysed.One hundred and thirteen constitutes brain tumors and remaining 25 constitute the spinal tumors. Of the total cases, 132 were primary CNS tumor and remaining six were secondary CNS tumor. In cranial, 61 (44.2%) were extra axial tumors. There were 122 low grade tumor and remaining 16 were high grade tumors. Tumors of neuroepithelial origin were the most common 54 (38.9%) CNS tumors followed by meningiothelial tumors 36 (26.0%).Tumor were equally distributed in both the sex.Mean age of study population was 37.38 years ranging from 0.5 years to 75 years.</p> <p><strong>Conclusions</strong><br />The present study concludes that the most common CNS tumour at our centre were neuroepithelial tumor mainly pilocytic astrocytoma followed by meningothelial. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pramod Chaudhary, Prakash Kafle, Sunil Munakomi, Babita Khanal, Narendera Joshi Lumbar Spondylosis: Occurrence by Gender and Age Strata at a Central Hospital, Ughelli in Nigeria 2022-01-13T17:51:49+00:00 Anibar Ese Efe Ahama Owarieta Edith Oghenekohwo <p><strong>Introduction</strong><br />Lumbar spondylosis (LS) is an abnormal growth of vertebral bones which is prevalent among individual and causes aging and trauma. The aim of the study is to determine the prevalence of LS at the Central Hospital, Ughelli.</p> <p><strong>Methods</strong><br />A purposive sampling technique was utilized and data was subjected to SPSS version 25. The study adopted a retrospective and descriptive study design, which involved 261 females and 113 males. Totality of 374 lateral radiographs of patients aged 18years and above were utilized.</p> <p><strong>Results</strong><br />LS was widespread among the subjects (n=298, 79.7%). It is found to be more prevalent among age group of 65-74 years, there was no significant association between age and occurrence of LS (x2 = 5.329; df = 1; n = 374; P = 0.255). In females LS was more prevalent among subjects in age group of 45-65 years while subjects &gt;74 years had the least prevalence. There was no significant age variation in the prevalence of LS among females (x2 = 4.553; df = 4; n = 261; P = 0.336). In males LS<br />was more prevalent among subjects in age group of 65-74 years while subjects in age group 35-44 years had the least prevalence. There was a significant age variation in the prevalence of LS among males (x2 = 13.559; df = 4; n = 113; P = 0.009).</p> <p><strong>Conclusions</strong><br />This study showed high occurrence of LS. Its pervasiveness is peaked at age 65-74 years and 45-54 years in males and females respectively. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Efe Ahama