https://www.nepjol.info/index.php/JCMSN/issue/feed Journal of College of Medical Sciences-Nepal 2022-10-20T05:09:14+00:00 Dr. Dipendra Khatiwada infojcms@gmail.com 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="http://www.cmsnepal.edu.np/jcms.html" target="_blank" rel="noopener">http://www.cmsnepal.edu.np/jcms.html</a>.</p> <p>Journal of College of Medical Sciences-Nepal is included on <a title="DOAJ" href="https://doaj.org/toc/2091-0657" target="_blank" rel="noopener">DOAJ</a>.</p> https://www.nepjol.info/index.php/JCMSN/article/view/42487 Microscopic Assistance in Cold Dissection Tonsillectomy – Does it Improve Surgical Outcome? 2022-01-18T14:38:44+00:00 Ashish Dhakal ashishdhakal@gmail.com Bikash Lal Shrestha bikashotology267602@gmail.com Monika Pokharel monikapokharel2020@gmail.com Krishna Sundar Shrestha krishnasundar082@yahoo.com Laxmi Khadka khadkalaxmi51@gmail.com <p><strong>Background:</strong> Tonsillectomy is one of the commonest surgical procedure carried out by ENT surgeon. In the post-operative period, rate of life-threatening post-operative bleeding varies between 0 and 20 % of the patients. The use of magnifying devices like microscopes or magnifying glasses is still in the focus of clinical investigation as it is hypothesized that precise vision of vessels during surgery allows precise coagulation and therefore reduces post-operative bleeding. Furthermore, precise coagulation should reduce post-operative pain too. The study aims to compare the surgical outcome between microscopic assisted tonsillectomy and traditional cold dissection tonsillectomy.</p> <p><strong>Methods:</strong> This prospective study was conducted on 32 patients who had undergone tonsillectomy from March 2020 to December 2021. The patients included in the study underwent cold dissection tonsillectomy where one tonsil was removed with Microscopic assistance and other with traditional cold dissection method with unsupported vision. Intraoperative blood loss was calculated. Post-operative pain score was measured with Wong- Baker FACES® Pain rating scale till 7th post-operative day. Post-operative complications if present were noted.</p> <p><strong>Results: </strong>Total of 32 patients were enrolled in the study with age ranging from 16-42 years. There were total 18 male (56.3%) and 14 females (43.8%) in the study. Intraoperative time for Microscopic assisted cold dissection (16.44 ± 3.46 minutes) was longer than Conventional dissection technique (13.94 ± 2.86 minutes) (p=0.04). Amount of blood loss during MCD technique was 16.47 ± 4.58 ml whereas in CD group it was 18.22 ± 4.54 ml (p=0.02). Pain score in both methods were higher during early post-operative period and gradually decreased with time. During rest, there was no statistically significant difference in pain between the two methods during first three post-operative days, after which pain was significantly reduced in MCD through day 4-7 (p &lt;0.05). None of the patient had post- operative hemorrhage requiring intervention in operation room.</p> <p><strong>Conclusions:</strong> Microscopic assisted cold dissection showed statistically significant results for reduced intraoperative blood loss and post-operative pain score than Conventional dissection method.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Ashish Dhakal, Bikash Lal Shrestha, Monika Pokharel, Krishna Sundar Shrestha, Laxmi Khadka https://www.nepjol.info/index.php/JCMSN/article/view/47897 Comparative Study of Intravenous Dexamethasone and Methylprednisolone in Severe COVID -19 Patients Requiring Respiratory Support in Intensive Care Unit 2022-08-30T07:56:11+00:00 Lalit Kumar Rajbanshi lalitrajbanshi@gmail.com Anuj Jung Rayamajhi anujrayamajhi@gmail.com Akriti Bajracharya akriti854@gmail.com Rajat Shah rajatshah2013@gmail.com <p><strong>Introduction: </strong>Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia.</p> <p><strong>Methods: </strong>Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables.</p> <p><strong>Results: </strong>At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly improved PaO2/FIO2 ratio (266.5260.73 vs 244.8175.36, P=0.029) and there was substantial decrease in inflammatory markers CRP, Ferritin (P&lt;0.05). PEEP requirement was significantly less with methylprednisolone (P=0.007). Methylprednisolone significantly reduced the incidence of multiorgan failure, need of invasive mechanical ventilation and duration of mechanical ventilation (P&lt;0.05). However, there was no significant difference in terms of duration of ICU stay and 30 days in hospital mortality between the two groups</p> <p><strong>Conclusions: </strong>Intravenous methylprednisolone significantly improved the oxygenation of COVID -19 pneumonia patients and decreased the inflammatory reactions as compared to similar dose of dexamethasone when given for week duration. However, methylprednisolone did not seem to be superior to dexamethasone in terms of improving mortality.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Lalit Kumar Rajbanshi, Anuj Jung Rayamajhi, Akriti Bajracharya, Rajat Shah https://www.nepjol.info/index.php/JCMSN/article/view/47222 Assessment of Sequelae of Untreated Dental Caries using PUFA index in Children Visiting a Tertiary Center in Kathmandu 2022-08-03T14:47:34+00:00 Sanskriti Khanal sans212@gmail.com Priyanka Shah picu.shah@gmail.com Anju Khapung saamik.2002@gmail.com <p><strong>Introduction</strong>: Dental caries is still a major health problem in most countries as it affects school aged children and adults also. Dental caries continues to be a major public health problem, especially in low and middle- income countries. It can be prevented and treated with proper utilization of dental services. Untreated dental caries can have pain and infection with significant impact on general<br />health.</p> <p><strong>Method</strong>: This study was conducted to assess the untreated dental caries in children using the pufa/PUFA index. A hospital based cross sectional study was carried out in 297 children aged 2-12 years old. Caries status was assessed by dmft/DMFT index and untreated caries by pufa/PUFA index.</p> <p><strong>Results</strong>: The “untreated caries PUFA ratio” of the population was 30.69%. The mean dmft index was 5.51<u>+</u>3.59, mean pufa 1.39<u>+</u>1.48 and mean DMFT 0.43+1.03 mean PUFA 0.11+0.46 respectively for primary and permanent teeth. Primary dentition had more caries and pufa score than the permanent teeth.</p> <p><strong>Conclusion</strong>: There were untreated caries present in the children showing lack of timely utilization of dental services.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Sanskriti Khanal, Priyanka Shah, Anju Khapung https://www.nepjol.info/index.php/JCMSN/article/view/47527 Peritonsillar Infiltration of Ropivacaine and Pain Control in Immediate Postoperative Period Following Tonsillectomy Surgery in Adult Patients 2022-08-15T15:14:48+00:00 Chhanya Bhandari drchhanya66@gmail.com Apar Pokharel aparpokharel@hotmail.com Naganavalachil Jayaprakash Mayya drchhanya66@gmail.com Ajay Singh Thapa drchhanya66@gmail.com <p><strong>Introduction: </strong>To study about the efficacy of Peritonsillar infiltration of Ropivacaine and pain control in immediate postoperative period following tonsillectomy surgery in adult patients.</p> <p><strong>Methods: </strong>80 patients were included in the study of age 18 to 50 years. After informed consent, patients were divided into two groups. In Group R 0.5%Ropivacaine with 1:100000 Adrenaline and in Group C 0.9%normal saline with 1:100000 Adrenaline was injected into the tonsillar fossa following tonsillectomy. Surgery duration, blood loss, time to demand for 1st analgesia, analgesic consumption in 24 hours, and VAS score in 1hr, 2hr, 4hr, 6hr, 12hr, 24hr were noted.</p> <p><strong>Results: </strong>We observed significant pain control during first 4 post-operative hours with Value of &lt;0.01, &lt;0.01 and 0.019 respectively in first, second and fourth post-operative score. We also observed significant difference in the time for first analgesia request in two groups with the study group requesting for first analgesic at 518±175 postoperative minutes and control group at 132±47.95 postoperative minutes (P value &lt;0.01). Total analgesia requirement was 61±22.48 in the study group and 102±27.84 in control group (P value &lt; 0.01).</p> <p><strong>Conclusions: </strong>It is concluded that intraoperative Peritonsillar infiltration of Ropivacaine causes analgesia in the immediate postoperative hours with the decrease in the requirement of analgesia in the first 24 postoperative hours. It is therefore recommended to use it in adult patient undergoing Tonsillectomy.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Chhanya Bhandari, Apar Pokharel, Naganavalachil Jayaprakash Mayya, Ajay Singh Thapa https://www.nepjol.info/index.php/JCMSN/article/view/46679 Relationship of Handgrip Strength and Endurance Time With Body Mass Index in Medical Students 2022-07-13T08:57:47+00:00 Chandra Kala Rai drchandrak79@gmail.com Sarbada Makaju sarbadamakaju@gmail.com <p><strong>Introduction: </strong>The sedentary lifestyle, unhealthy eating habits and obesity are major health problems of current generation. High body mass index is directly related with high mortality rate, cardiovascular diseases, mental issues and difficulty in physical functioning. Normal weight and strength of muscle are indications of good health. Handgrip strength and endurance are the important parameters to assess the upper extremity muscular strength.</p> <p><strong>Methods: </strong>This is a descriptive cross-sectional study in 400 medical students in Kathmandu Medical College, Bhaktapur (October 2021 to March 2022) with Institutional Review Committee approval (Reference no. 0106202102). The sample was collected by simple random sampling method. Height and weight were measured by Prestige stadiometer and body mass index was calculated. Student’s dominant hands grip strength and endurance time was measured by manual Grip Dynamometer. Data was analyzed by Statistical Package of Social Science (SPSS) software version 16 with Chi-square test.</p> <p><strong>Results:</strong> Among 400 samples, female 217 (54.25%) and 183 (45.75%) were males. Female students with normal, overweight and pre-obese BMI had maximum and highly significant (p value = 0.00, 0.001 and 0.003 respectively) relationship with grip strength. Normal, pre-obese and obese male had highly significant relation with grip strength (p = 0.004, 0.00 and 0.002 respectively). Normal body mass index samples had maximum endurance time along with overweight male.</p> <p><strong>Conclusion: </strong>The normal body mass index samples had significant relation with hand grip strength and highest endurance time</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Chandra Kala Rai, Sarbada Makaju https://www.nepjol.info/index.php/JCMSN/article/view/45504 Influence of Aging on HbA1C: A Cross-Sectional Study on Diabetic Population Attending a Tertiery Care Center of Central Nepal 2022-06-02T09:15:32+00:00 Manoranjan Adak manoranjanadak@rediffmail.com Hari Prasad Upadhyay hpchalise@gmail.com <p><strong>Background: </strong>Diabetes mellitus is increasing day by day throughout the globe. So, early diagnosis of diabetes is crucially important in reduction of the complications. This study was conducted to determine the correlation between glucose monitoring by fasting blood glucose and two hours postprandial blood glucose with glycated hemoglobin (HbA1c) in diabetic patients and evaluate whether glycohemoglobin levels increase with age in both sexes</p> <p><strong>Methods: </strong>A hospital-based analytical cross-sectional study was carried out from March 2020 to December 2021 in diabetic patients attending at outpatient department (OPD) of College of Medical College and Teaching Hospital, Bharatpur, Chitwan. The total number patients was 696 people. HbA1c, fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were analyzed.</p> <p><strong>Results: </strong>Both postprandial blood glucose and fasting blood glucose significantly correlated with HbA1c. Postprandial blood glucose showed better correlation to HbA1c than fasting blood glucose (r = 0.630, P &lt;0.001 vs. r =0.452, P = 0.05).</p> <p><strong>Conclusions: </strong>These results show that postprandial blood glucose correlated better than fasting blood glucose to HbA1c. Thus, postprandial blood glucose predicted overall glycemic control better than fasting blood glucose. Based on our study, we may concluded a significant correlation exist between age and HbA1c in Nepalese population.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Manoranjan Adak, Hari Prasad Upadhyay https://www.nepjol.info/index.php/JCMSN/article/view/44242 Perceived Hindering Factors of Exclusive Breastfeeding among Lactating Mothers of Itahari 2022-06-02T11:26:31+00:00 Rita Pradhan ritapradhan321@gmail.com Basant Kumar Karn basantkarna@bpkihs.edu Ramanand Chaudhary ramanandachaudhary@yahoo.com Upendra Yadav upendrayadav@bpkihs.edu Sunita Bhandari niksunita@gmail.com <p><strong>Introduction: </strong>World Health Organization recommends first 6 months of exclusive breastfeeding after birth. It helps in proper growth and development of child. At the same time, it reduces infant mortality by preventing common childhood illnesses and helps for a quicker recovery during illness. So, the study aimed to identify the perceived hindering factors of exclusive breastfeeding among lactating mothers.</p> <p><strong>Methods: </strong>A community-based, descriptive cross-sectional study was conducted in Itahari Sub-Metropolitan City. Convenience sampling technique was used to select a total of 123 lactating mothers having infants 0-6 months. A pretested questionnaire was used to interview mothers. Collected data were analyzed using descriptive and inferential statistics.</p> <p><strong>Results: </strong>Although nearly all mothers (97.6%) had knowledge about exclusive breastfeeding and 93.5% of them had correct knowledge of recommended duration of EBF, the prevalence of exclusive breastfeeding was only 17.6%. Breastfeeding was initiated within 1 hour by 68.3% of mothers. Half of the mothers perceived that only mother’s milk is not sufficient to their child and about 22% of the mother’s perceived that their child is thirsty and should give water to the infant. Ethnicity and EBF duration to first child in multiparous mother was significantly associated with exclusive breastfeeding practice.</p> <p><strong>Conclusions: </strong>Majority of the mothers do not practice EBF although they had known the recommended duration. The major hindering factor of EBF was the perception of the mother that the mother’s breastmilk only is not sufficient to the infant.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Rita Pradhan, Basant Kumar Karn, Ramanand Chaudhary, Upendra Yadav, Sunita Bhandari https://www.nepjol.info/index.php/JCMSN/article/view/47475 Functional And Radiological Outcome of Schatzker Type V and VI Tibial Plateau Fracture Treated with Closed Reduction and Ilizarov Fixation with or without Minimally Invasive Screw Supplementation 2022-08-13T06:46:58+00:00 Suresh Pandey drsuresh.orthonepal@gmail.com Suraj Bidary bidary.suraj@gmail.com <p><strong>Introduction: </strong>Controversy exists as to the best treatment approach for high-velocity tibial plateau fractures. This study was done to assess the functional and radiological outcome of Schatzker type V and VI tibial plateau fractures treated with closed reduction and Ilizarov ring fixation with or without cancellous screw supplementation.</p> <p><strong>Methods: </strong>An analytical cross sectional study was conducted among 25 cases of both closed and open Schatzker type V and VI tibial plateau fractures treated with closed reduction and Ilizarov ring fixation with or without minimally invasive cannulated cancellous screw supplementation. The outcome variables analyzed were union time, knee range of motion, American Knee Society Score (AKSS), Rasmussen’s Radiological Score (RRS), and complications. Data analysis was done using SPSS-20. P-value &lt;0.05 was considered as statistically significant.</p> <p><strong>Results: </strong>There were 15 type V fractures, 10 type VI fractures, 21 closed fractures, and 4 open fractures. All the fractures united with a mean union time of 15.88 weeks (range 12-24). The mean American Knee Society score was 77.8 (range 68-95), Rasmussen’s radiological Score (RRS) 15.12 (range 10-18), and mean range of motion was 112.40 (range 90-135). Superficial pin site infection was present in 7 (28%) of the cases. There was no case of nonunion, deep infection, repeat surgery other than implant removal, or nerve palsy.</p> <p><strong>Conclusions: </strong>Closed reduction and Ilizarov ring fixation with or without minimally invasive screw supplementation give rise to good to excellent functional and radiological outcomes in most of the cases in the treatment of Schatzker type V and VI tibial plateau fractures with minimal bone or soft tissue related complications.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Suresh Pandey, Suraj Bidary https://www.nepjol.info/index.php/JCMSN/article/view/47444 Prescribing Pattern of Antibiotics in ENT Outpatients of Tertiary Care Hospital in Bharatpur, Nepal 2022-08-12T05:08:51+00:00 Anish Giri girianish80@gmail.com Apar Pokharel aparpokharel@hotmail.com Anjan Palikhey anjanpalikhey@gmail.com Hari Prasad Upadhyay hpchalise@gmail.com Bijaya Laxmi Giri bijaya2aayan@gmail.com <p><strong>Introduction: </strong>Upper respiratory tract infection (URTI) like pharyngitis, tonsillitis, sinusitis, laryngitis and otitis media are the most common infections encountered in ENT outpatients. As these infections are caused by the microorganism they should be treated with the antimicrobial agents. The aim of this study was to determine the prescribing pattern of antibiotics in ENT outpatients of tertiary Care Hospital in Bharatpur, Nepal.</p> <p><strong>Methods: </strong>It was prospective observational study which was carried out in the ENT Department of College of Medical Science, Bharatpur, Chitwan, Nepal. Total 267 prescriptions were studied. Patient of all age groups and sex were included in the study. Prescriptions were evaluated based on the World Health Organization (WHO) core drug prescribing indicators. Results on categorical measurements are presented in numbers and percentage which was used to generate tables and graphs. Data analysis was done by SPSS software version 20.0.</p> <p><strong>Results: </strong>A total of 267 prescriptions were collected and analyzed during the study. Average number of drugs per prescription was 3.12 in which average number of antibiotic per prescription was 1.041. Commonly prescribed antibiotics belongs to the penicillin group (52%) followed by macrolide (27%). Most of the drugs were prescribed by their brand names (92%). Besides antibiotics the common adjuvant drugs that are being prescribed were nasal decongestant (44%) followed by anti-histaminics (27.7%).</p> <p><strong>Conclusions: </strong>The present study highlights the wide use of Amoxicillin and clavulanic acid combination for ENT infections. Measures to emphasize the use of generic names are necessary to promote rational drug use.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Anish Giri, Apar Pokharel, Anjan Palikhey, Hari Prasad Upadhyay, Bijaya Laxmi Giri https://www.nepjol.info/index.php/JCMSN/article/view/48700 Prevalence and Correlation of Hypertension, Obesity and Diabetes Among Adults Visiting Community Based Screening Programs 2022-09-30T12:15:39+00:00 Prerna Bansal drprernabg@gmail.com Ayasha Shrestha aaayasha.shrestha@gmail.com Srijana Panthi srijanapanthi2043@gmail.com <p><strong>Introduction: </strong>According to the World Health Organization, diabetes, hypertension and obesity are one of the top five continuing risk factors for cardiovascular deaths in the world. Hypertension and obesity increase the risk of long-term vascular complications of type 2 diabetes mellitus. This study aims to find the prevalence and correlation of hypertension, obesity and diabetesamong the adults in<br />central part of Nepal.</p> <p><strong>Methods: </strong>An analytical cross-sectional study was conducted among 233adults visiting the community based screening programs in Bharatpur-10, Nepal organized by College of Medical Sciences during July 2022 to August 2022. Descriptive analysis was done to find the frequency, percentage and mean.To find the association between continuous variables correlation was used (p-value &lt;0.05).</p> <p><strong>Results: </strong>The mean age was 53.71±12.42 years, 60.9% males and 39.1% females. The prevalence of hypertension was found to be 25.7%, obesity was 21.8% and diabetes was 36.5%.The FBS was positively correlated with age, SBP, DBP and BMI. The correlation of FBS with age (p-value 0.05) and SBP (p- value 0.01) was found to be statistically significant.</p> <p><strong>Conclusions: </strong>The prevalence of hypertension, obesity and diabetes were found to be high both in male and female adults visiting the community based screening programs. Fasting blood glucose was found to be positively correlated with age, body mass index, systolic and diastolic blood pressure measurements of the patient. Thus, level of fasting blood sugar level increases with increasing age, increasing body mass index, increasing systolic and diastolic blood pressure levels of the patient. </p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Prerna Bansal, Ayasha Shrestha, Srijana Panthi https://www.nepjol.info/index.php/JCMSN/article/view/48715 HRCT Chest in Patient of COVID-19 Pneumonia at a Tertiary Care Hospital of Central Nepal 2022-10-02T10:11:56+00:00 Rajesh Acharya rajes164@gmail.com Pramod Kumar Chhetri dr.chhetripramod@gmail.com V. Natraj Prasad directorcmsth@gmail.com Kalim Akhtar dr.kalimakhtar@gmail.com Kripesh Thapa kripeshthapa8266@gmail.com Manish Mishra zestzeal111@gmail.com Arati Ghimire rtgmere@gmail.com <p style="font-weight: 400;"><strong>Background: </strong>COVID19 pneumonia is caused by novel corona virus. The HRCT chest is helpful in identification of COVID-19 Pneumonia. CT chest play a crucial role in assessing the pattern of manifestation and severity of lung involvement in COVID-19. The objective of this study is to described high resolution computed tomography (HRCT) chest findings in COVID-19 Pneumonia patients in college of medical sciences Bharatpur Nepal.</p> <p style="font-weight: 400;"><strong>Method: </strong>A prospective, HRCT Chest findings were analaysed in 375 patients. Patients with high CORADS score and suspicious for COVID-19 pneumonia were further tested positive in PCR examination. The study was done for a year period of time</p> <p style="font-weight: 400;"><strong>Result: </strong>A total 375 patients suspected for COVID-19 pneumonia in HRCT, 341 were PCR positive. The mean age affected by viral pneumonia was 51.9 (51-60 year group). The male were 240 and female were 135. Ground glass opacities is noted in 188 patients, followed by GGO and consolidation in 177, consolidations only in 7 and others findings chest findings in 3 patients.</p> <p style="font-weight: 400;"><strong>Conclusion: </strong>HRCT chest can help in early detection of COVID-pneumonia. It can also asses the percentages of lung involvement and severity of disease that can guide physician.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Rajesh Acharya, Pramod kumar Chhetri Chhetri, V.Natraj Prasad, Kalim Akhtar, Kripesh Thapa, Manish Mishra, Arati Ghimire https://www.nepjol.info/index.php/JCMSN/article/view/29691 Facultative Anaerobic Bacterial Profile of Bacteremia and Septicemia among ICU Patients and its Antibiotic Susceptibility Pattern in Central Nepal 2021-03-14T08:56:22+00:00 Brajesh Kumar Jha baiju010@gmail.com Suryanarayan Mahaseth dosurya@gmail.com Rajkumari Sanjana rajkumari_sanjana@yahoo.com <p><strong>Introduction: </strong>Bacteremia and septicemia is a life threatening condition resulting in major cause of morbidity and mortality in patients. The aim of this study was to determine prevalence of bacteremia and septicemia among surgical ICU patients and its antibiotic susceptibility pattern.</p> <p><strong>Methods: </strong>A cross-sectional study was carried out among the suspected cases from surgical ICUs of COMS-TH from July 2017 to December 2020. Blood samples were collected, processed, isolated and identified according to standard methodology. Multidrug resistance in Gram negative bacterial (MDR) and methicillin resistant <em>S.aureus </em>(MRSA) screening was done by following the standard protocol.</p> <p><strong>Results: </strong>A total number of 450 samples were processed, 48(10.7%) bacterial isolates from patients’ blood sample showed positive by culture from department of surgical ICUs, College of Medical Sciences Teaching Hospital, Nepal. This study showed more incidences of gram negative isolates which are responsible for septicemia as compared to gram positive isolates.</p> <p>Most frequently used drugs like Ciprofloxacin (83.9%), Gentamycin (74.2%), Ceftrixone and Ampicillin (71.0%), Cefazolin and Chloramphenicol (67.7%), Ofloxacin (67.7%), Amikacin (64.5%), Amoxyclave (61.3%), showed high rate of resistance among the isolates. Cefotaxime and Co-Trimoxazole (58.1%) showed second highest resistance pattern among GNB isolates from ICU patients. The least resistance pattern among the GPC was found in drugs like Amikacin and Azithromycin (47.1%) and Vancomycin (35.3%) Meropenem (29.4%). Coagulase negative <em>Staphylococcus </em>(CONS) had shown MDR 66.6% showed highest resistance pattern among <em>Enterococcus </em>spp, CoNS and <em>S.aureus</em>. This indicates most of the organisms were either moving towards resistance or already acquired resistance against antibiotics.</p> <p><strong>Conclusions : </strong>Blood culture positive rate of the isolates from surgical ICUs of COMS-TH was 48(10.7%) of the total 450 samples. <em>Pseudomonas aeruginosa </em>and <em>S.aureus </em>were most common pathogen causing bacteremia and septicemia. None of the antibiotics were 100% sensitive for <em>P.aeruginosa, </em>even Meropenem showed reduced sensitivity. Among all antibiotics Ampicillin and Amikacin followed by Ciprofloxacin has lowest sensitivity towards the organisms.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Brajesh Kumar Jha, Suryanarayan Mahaseth, Rajkumari Sanjana https://www.nepjol.info/index.php/JCMSN/article/view/47833 Awareness on Prevention of Complication Related to Immobility among Caregivers of Bedridden Patients in Tertiary Health Care Center in Chitwan 2022-08-26T17:01:08+00:00 Binita Dhakal bineetadhakal@gmail.com <p><strong>Introduction: </strong>Immobility is a condition in which a person is unable to move freely or movement is restricted for medical reasons. Prolonged bed rest and immobilization inevitably leads to complications. Caregivers play a vital role in preventing the complications of immobilization and avoiding discomfort for the patient. This study aims to assess awareness on prevention of complications of immobility among caregivers of bedridden patients admitted in tertiary health care center.</p> <p><strong>Methods: </strong>A descriptive cross-sectional research design was used to assess 66 caregivers of college of medical sciences by using non-probability convenience sampling technique. Data was collected by using self-administered questionnaire to assess awareness through face-to-face interview method. Obtained data were analyzed by using descriptive and inferential statistics using IBM SPSS 16.</p> <p><strong>Results: </strong>Study findings revealed that the mean age of the respondents was 18 years with mean age 18 ± 11.87 and majority (54.5%) were female with higher percentage of respondents’ involvement in agriculture (28.3%). Majority (68.2%) of the respondents stayed in hospitals for 1 to 5 days and 51.5% respondents had no previous experience of hospital stays. Among the total respondents, majority (83.3%) had inadequate awareness on prevention of complication related to immobility which varied with respondent’s gender (p=0.047), educational level (p=0.001), occupation (p=0.0026) and information from television (p=0.005).</p> <p><strong>Conclusions: </strong>Majority of the respondents had inadequate awareness on prevention of complication related to immobility. Findings emphasize that awareness programs should be implemented time to time in hospital settings to update the caregivers in relation to preventive measures of complications of immobilization.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Binita Dhakal https://www.nepjol.info/index.php/JCMSN/article/view/47042 Virtual Anatomy Learning in a Medical College in Eastern Part of India during Pandemic 2022-07-28T05:19:01+00:00 Sunandita Nath sunandita66@gmail.com Satarupa Paul Ghosh satarupapaul21@gmail.com Sumita Sinha sumitasinhanrsmc@gmail.com <p><strong><span lang="EN-GB">Introduction: </span></strong><span lang="EN-GB">The fundamental cornerstone of medical education is Anatomy which specially requires a 3D visualization of human body by traditional mode of teaching. During covid-19 pandemic it was forcefully stopped by introducing newer virtual teaching program. This had offered an opportunity to explore blending of newer methods with traditional one.<strong> </strong>To find effectiveness of online classes in anatomy during pandemic. And to find out whether online teaching hampers inter-personal relationship. </span></p> <p><span lang="EN-GB"><strong>Methods: </strong></span><span lang="EN-GB">Data obtained through questionnaire from 230 first year MBBS students’ responses at R.G. Kar Medical College and Hospital were recorded and analysed.</span></p> <p><strong>Results: </strong>50% of the students were in favour of virtual learning process, 34% were satisfied with online mode as independent mode of learning, 61% responded that online teaching will be helpful for the advancement of their career.</p> <p><strong>Conclusions: </strong>The pre-recorded online demonstration classes are better appreciated by the students than hand role playing (which is important in NMC criteria) online classes. Some topics are better taught through online mode than offline method. </p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Sunandita Nath, Satarupa Paul Ghosh, Sumita Sinha https://www.nepjol.info/index.php/JCMSN/article/view/48994 Epidemiological Study of Organophosphorus Poisoning at a Tertiary Care Hospital of Central Nepal 2022-10-20T05:09:14+00:00 Manohar Pradhan drmpcms@gmail.com Hari Prasad Upadhyay hpchalise@gmail.com Ayasha Shrestha aaayasha.shrestha@gmail.com Alok Pradhan aalokpradhan@gmail.com <p><strong>Introduction</strong>: Poisoning is an acute medical emergency. Organophosphorus (OP) poison, being easily available and relatively cheaper, is mostly used by people for suicide. It is a major health problem worldwide also a major cause of suicide in Nepal. The purpose of this study was to assess the overall profile of patients with Organophosphorus (OP) poisoning.</p> <p><strong>Methods:</strong> A Prospective hospital based descriptive cross-sectional study was conducted on patients of organophosphorous poisoning in the emergency department (ER) of College of Medical Sciences and Teaching Hospital during one year period from 1<sup>st</sup> January 2020 to 31<sup>st</sup> December 2021. Data analysis was done using SPSS-16 software. Categorical variables were presented in the form of tables with frequency and percentage. Data was analyzed by using descriptive statistical tools.</p> <p><strong>Results</strong>: A total of 123 OP poisoning cases attended in the emergency department of College of Medical Sciences over a period of one year. The overall female to male ratio was 1.19:1. Most poisoning occurred in the age group 15-25yrs. Majority of the patients were married and were students. Oral route (87.83%) was the most common route of administration. The main reason was family and personal issues. Majority of the patients stay 3-7 days in the hospital. The mortality of poisoning was 3.25%.</p> <p><strong>Conclusions:</strong> Majority of the intentional poisoning occurred in the female, married &amp; students of younger age group. The main reason was family and personal issue.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Manohar Pradhan, Hari Prasad Upadhyay, Ayasha Shrestha, Alok Pradhan https://www.nepjol.info/index.php/JCMSN/article/view/47979 Case of Self-Mutilation –Lesch-Nyhan Syndrome 2022-09-01T15:27:31+00:00 Sweta Kumari Gupta doctorsweta84@gmail.com Samanata Dallakoti dallakotisamanata@gmail.com Ranjit Sapkota dr.rsapkota@gmail.com Niraj Sangroula Drniraj.sang@gmail.com <p>Lesch-Nyhan syndrome involves a congenital error of purine metabolism, due to the absence (or very low levels) of hypoxanthine-guanine phosphoribosyltransferase (HPRT) enzyme. The classic clinical phenotype of LNS was first described by Michael Lesch and William Nyhan in 1964 and is characterized by hyperuricemia, intellectual disability, severe motor deficiency, and recurring self-mutilation . Here we present a case of a 4-year-old male child with features of self-mutilation, aggression, and poor neck control and unable to sit and stand. we diagnosed him as a case of Lesch-Nyhan syndrome based on clinical features and slight hyperuricemia. Due to the lack of medical facilities, many cases of Lesch-Nyhan syndrome undergo unnoticed in many underdeveloped countries.</p> 2022-11-04T00:00:00+00:00 Copyright (c) 2022 Sweta Kumari Gupta, Samanata Dallakoti, Ranjit Sapkota, Niraj Sangroula