Journal of College of Medical Sciences-Nepal <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> International Society of Medical Education Pvt. Ltd. en-US Journal of College of Medical Sciences-Nepal 2091-0657 Estimation of Tactile Discriminatory Fitness in Hands of Public Transport Drivers <p><strong>Background:</strong> Public transport drivers are constantly being exposed to stimuli and are at risk of disorder of peripheral nervous system which can be further complicated by comorbidities. Thus, we wanted to examine intactness of tactile discriminatory ability in healthy drivers by comparing it to healthy samples of non-driving population. Since two point discrimination (TPD) test is frequently used for neurological assessment of tactile stimulation we determined and compared various locations in hands of two populations.</p> <p><strong>Methods:</strong> Participants were asked to answer whether they feel one point or two points touch by blunted end of simple compass divider in their hand. The minimum distance between the points at which the participants could answer correctly was noted as two point discrimination value.</p> <p><strong>Results:</strong> Drivers had TPD range of 2-4mm with mean 2.53±0.62 and, 1-4mm with mean 2.6±0.72 at middle finger of right and left hand respectively. Following t-test between drivers versus students, significant difference in the mean TPD value in the proximal palm supplied by median nerve (p=0.016) and proximal palm corresponding to ulnar nerve (p=0.032) on the right hand was found. On the left hand, significant difference in the mean TPD value is found in the proximal palm corresponding to median nerve (p=0.008) and ulnar nerve (p=0.043) respectively.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong> Healthy public transport drivers have less tactile discriminating prowess at proximal palmar surface of hand. Examined distal phalanges and distal palm showed no significant difference in mean of TPD values for healthy drivers versus students.</p> Ojashwi Nepal Samjhana Thapa Roshan Kasti Reena Kumari Jha Mrigendra Amatya ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.27508 Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients with Obstructive Jaundice <p><strong>Background: </strong>Jaundice is a common presenting symptom in patients with hepatobiliary disease. It can be categorized into medical and surgical jaundice and it is important to differentiate due to the different treatment options</p> <p>&nbsp;<strong>Methods: </strong>In this cross sectional study from Jan 2017 to June 2018, 84 consecutive patients with&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; obstructive jaundice who underwent initial USG and then MRCP were included and their respective diagnosis compared keeping surgery and/or histopathology as the gold standard for final diagnosis.</p> <p>&nbsp;<strong>Results: </strong>Out of 84 patients, 67.9% were females and 32.1% were males. The most common cause for obstructive jaundice was benign in 72.6% and malignancy in 27.4%. Among the benign lesions&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; choledocholithiasis was the most common (57.4%) followed by pancreatitis&nbsp; (26.2%).&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Cholangiocarcinoma was the most common malignant cause (47.8 %) followed by periampullary&nbsp; carcinoma (26.2%). The sensitivity and specificity of USG in benign lesions was 67.2% and 87%&nbsp; respectively, and in malignancy 56% and 95% respectively. Similarly sensitivity and specificity of MRCP for benign lesions was 95.2% and 90.9% respectively, and for malignancy 95.75% and 98.45%respectively. Overall diagnostic accuracy of USG in benign and malignant causes was 76.62% and 84.52% respectively. Similarly overall diagnostic accuracy of MRCP for benign and malignant causes was 93.98% and 97.6% respectively.</p> <p>&nbsp;<strong>Conclusions: </strong>USG is a good modality for Initial screening and for differentiating&nbsp; medical and surgical cause of jaundice. MRCP is a better modality with higher sensitivity, specificity and diagnostic accuracy for detecting pathology as compared to USG.</p> <p><strong>Keywords: </strong>MRCP; obstructive jaundice; USG.</p> <p>&nbsp;</p> Pramod Chhettri Hari Rana ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.26641 Amoxicillin Induced Behavioral Neurotoxicity and Histopathological Changes in Organs of Albino Rats <p><strong>Background</strong>: There are various adverse drug reactions of penicillin. Neurotoxicity is attracting the attention of researchers all over the world. It also affects other organs like liver, kidney, heart and testes</p> <p><strong>Methods</strong>: The study was conducted at pharmacy and pharmacology department of Gandaki Medical College (GMC) from January till April, 2018. Albino rats were divided six each in test and control group. Tests were administered amoxicillin 90mg/kg/d and control with distilled water for 10 days. After 10 days, rats were tested for neurotoxicity with rota-rod (RR) and modified forced swim test (MFST). They were then sacrificed under anesthesia, organs were dissected and sent for histopathological investigation.</p> <p><strong>Results:</strong> The latency to fall from RR apparatus decreased significantly in test rats than control. (P value = 0.0001) In MFST, immobility time was significantly increased than control (P value = 0.0001). Swimming time(ST) was significantly decreased (P value = 0.001) and climbing time (CT) was not significantly altered in test rats than control (P value = 0.352). The liver enzyme, AST and ALT were significantly increased in the test rats (TR) as compared to controls. (P value 0.049 and 0.001 respectively) Brain of test rats (TR) showed shrunken neurons surrounded by perineuronal vacuolations, liver and kidney showed degenerative changes. Vacuolations and pyknotic cells were seen in spermatogonic cells.</p> <p><strong>Conclusions</strong>: Neurotoxic effects were seen in test rats which recommends regulation of the administration of high dose of penicillin.</p> Sabita Paudel Bijay Aryal Sunita Ranabhat ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.25282 Effect of Occlusal Reduction on Postoperative Pain in Teeth with Irreversible Pulpitis and Mild Tenderness to Percussion <p><strong>Background: </strong>One of the most important aspects during endodontic treatment is to control pain during and after root canal treatment. Occlusal reduction has been widely used after root canal treatment to&nbsp;&nbsp;&nbsp;&nbsp; reduce post treatment pain and flare up. The purpose of this study was to evaluate the effect of occlusal reduction on postoperative pain in teeth with irreversible pulpitis and tenderness to percussion.</p> <p><strong>Methods: </strong>Forty-eight patients with irreversible pulpitis and mild tenderness to percussion were allocated into two groups; occlusal tooth reduction group and no occlusal tooth reduction group. After root canal instrumentation, patients were recalled after 24 hours, 2<sup>nd</sup> day, 3<sup>rd</sup> day, 4<sup>th</sup> day, 5<sup>th</sup> day and 6th day to&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; record their postoperative pain on the Visual Analogue Scale. The final outcome that is mean post&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; instrumentation pain score was measured till 6 days of post instrumentation. Data was collected and&nbsp;&nbsp;&nbsp;&nbsp; entered in Microsoft Excel sheet and analysis was done using Statistical Package of Social Sciences&nbsp;&nbsp;&nbsp;&nbsp; software version 20.&nbsp;</p> <p><strong>Results: </strong>There was no significant difference in postoperative pain between the 2 groups (P &gt; .05) after root canal preparation.</p> <p><strong>Conclusions: </strong>Occlusal surface reduction did not provide any further reduction in postoperative pain for teeth with irreversible pulpitis and mild tenderness to percussion compared with no occlusal reduction.</p> <p><strong>Keywords: </strong>endodontic preparation; occlusal reduction; postoperative pain; root canal treatment.</p> <p>&nbsp;</p> Siddharth Ghimire Punam Basnet Dixit Deepak Kumar Roy Sweta Dhital Sirjana Dahal ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.26776 Prevalence and Associated Factors of Depression among People Who Attempt Suicide <p class="Default" style="text-align: justify; text-justify: inter-ideograph; line-height: 150%;"><strong>Background:</strong>Suicide is the act of taking one's own life. Suicidal attempts, (both fatal and nonfatal) are a challenging public health issue. Suicide causes heavy morbidity and mortality in the most productive group of a community. This study was aimed to calculate the prevalence rate of major depressive disorder among persons who attempted suicide and also to measure the severity of suicidal ideation.</p> <p class="Default" style="text-align: justify; text-justify: inter-ideograph; line-height: 150%;"><strong>Methods: </strong>The study involved 50 persons above 18years of age of both sexes who has attempted suicide in the recent past. An informed consent was obtained from all of them. The prevalence of depression among those suicide attempters was studied based on major ICD- 10 depression inventory. Also, suicide intent rating based on Beck’s suicide intent scale was done to assess the severity of suicide attempt. Questionnaire was given and the details were collected.</p> <p class="Default" style="text-align: justify; text-justify: inter-ideograph; line-height: 150%;"><strong>Results: </strong>The prevalence of depression is estimated to be 38% (with 95% CI 25.86% to 51.85%) among the suicide attempters and 10% showed high intent for suicide.statistically significant factors are age (p-value &lt;0.001), gender (p-value=0.002) and suicide intent (p-value &lt;0.001).</p> <p class="Default" style="text-align: justify; text-justify: inter-ideograph; line-height: 150%;"><strong>Conclusions: </strong>Prevalence of depression is common among people who attempt suicide. Early diagnosis and intervention will reduce suicide attempts.</p> Riju Niroula ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.25367 Prevalence and Antibiogram of Acinetobacter Species Isolated from Various Clinical Samples in a Tertiary Care Hospital <p><strong>Background: </strong>Acinetobacter species has emerged as a significant hospital pathogen, and are becoming&nbsp; &nbsp; &nbsp; &nbsp; increasingly drug resistance. They cause outbreaks in intensive care units and health care units.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted to determine the prevalence and antibiotic susceptibility pattern of <em>Acinetobacter</em> spp isolated from various clinical samples collected from patients admitted in various wards and intensive care units of the hospital over a period of one year (March 2018 to Feb 2019). <strong>&nbsp;</strong></p> <p><strong>Results: </strong>Out of 2,623 samples, 1,201(45.78%) yielded significant growth and out of these positive cultures, 138(11.49%) <em>Acinetobacter</em> spp were isolated. Majority of isolates 24(17.39%) were isolated from General intensive care unit (GICU). Maximum sensitivity of <em>Acinetobacter</em> spp was seen towards polymyxin B 138(100%) and colistin 138(100%), followed by tigecycline 127(92.02%). Hundred and one (80.43%) isolates were found to be multidrug resistant. &nbsp;</p> <p><strong>Conclusions</strong>: <em>Acinetobacter</em> isolates showed multidrug resistant pattern mostly in inpatients. To avoid resistance, antibiotics should be used judiciously. There is also an urgent need for emphasizing the&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; importance of hand washing and use of disinfectants in prevention of transmission of infection in health care setup.</p> <p><strong>Keywords: </strong><em>Acinetobacter</em> spp; prevalence; antibiotic resistance; intensive care units; multidrug&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; resistance.</p> <p>&nbsp;</p> Sanjana Raj Kumari Shanti Pradhan Damodar Sharma Brajesh Jha ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.28224 Retrospective Analysis of Clinical Outcome of Intraoperative Epidural Steroid Injection Versus No Steroid Injection after Standard Lumbosacral Discectomy <p><strong>Background</strong>: Despite operative decompression of neural structure with discectomy in the indicated cases of lumbosacral disc herniation, many patients continue to experience back pain and leg pain in the postoperative period. Use of intraoperative local epidural steroid injection has been in practice to reduce this complications but there are concern and controversies regarding its benefit and risk. So this study aims to analyze clinical outcome in terms of reduction in pain, hospital stay, postoperative use of analgesics and risk associated with the use of intraoperative epidural steroid &nbsp;locally and comparison to those who did not receive steroid.</p> <p><strong>Methods</strong>: This was a retrospective analysis of total of 44 patients, 28 patients who received Epidural Steroid Injection (ESI) locally after lumbosacral standard discectomy and comparison of the outcome with results of 16 patients with standard lumbosacral discectomy who did not receive ESI. Outcome measurement was done between two groups in terms of postoperative pain VAS scale, use of analgesics, hospital stay and complications if any.</p> <p><strong>Results</strong>: There were total of 44 cases (28 steroid group and 16 no steroid group) with mean age of 39.93 years, male 27 and female 17 who underwent standard discectomy and followed up for at least one year. Overall, preoperative mean VAS score for pain improved from 7.95 to 1.55 at 1 year after operation which was significant p&lt;0.05. On comparison of 24 hour postoperative VAS score and&nbsp; hospital stay between the groups with steroid and no steroid, it was mean of 5.32 versus 6 and 4.43 days versus 5.25 days (p&lt;0.05) respectively which was significant. All the patients in no steroid group needed both NSAID and opioids for the postoperative pain management whereas only 12 (42.8%) patient needed addition of opioids in steroid group. There was no difference in VAS score at 1week and 1 year. There was no complications in either of the group.&nbsp;</p> <p><strong>Conclusions</strong>: Use of intraoperative ESI help to reduce early postoperative pain, hospital stay and use of opioids without adding further risk or complication.</p> Suresh Pandey Suraj Bidari ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.26853 Clinicodemographic Profile and Outcome of Patients with Symptomatic Meckel's Diverticulum: Preliminary Findings <p><strong>Background</strong>: Meckel's diverticulum is the commonest gastrointestinal congenital anomaly. Though most of the cases do not present clinically, they are challenging to diagnose if become symptomatic. Spectrum of clinical presentation may be different from umbilical fistula, omphalomesenteric cyst&nbsp; to fibrous band from diverticulum&nbsp; to umbilicus. Bleeding, obstruction and infection are the most common complications. Vast majority of them are detected only intra-operatively. &nbsp;</p> <p>&nbsp;<strong>Methods</strong>: We analyzed our patients who were intra-operatively diagnosed as symptomatic Meckel's Diverticulum. Socio-demographic profile and immediate outcome of operated patients was analyzed from patient's records.</p> <p>&nbsp;<strong>Results</strong>: Total 9 patients were operated for symptomatic Diverticulitis. All patients were diagnosed intraoperatively. Intestinal obstruction was the commonest presentation.&nbsp;Diverticulectomy was the most common procedure performed followed by wedge resection and segmental bowel resection.</p> <p>&nbsp;<strong>Conclusions</strong>: Symptomatic Meckel’s Diverticulum is difficult to diagnose pre-operatively. Vast majority of them are found only intra-operatively. Most of the patients do well after resection of Meckel's Diverticulum.</p> <p><strong>&nbsp;</strong><strong>Keywords: </strong>Meckel’s diverticulum; surgery; symptoms.</p> Pravin Joshi Narayan Belbase Rohit Kumar Mishra Mukesh Karki Lalit Kumar Das ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.26769 Variation in Formation of Renal Artery <p><strong>Backgrounds:&nbsp;</strong>Renal arteries are two large blood vessels branching laterally from the abdominal aorta just below the superior mesenteric artery. The arteries vary in their level of origin and caliber, obliquity and precise relations. Each renal artery is about 6-8mm diameter. There is a varying characteristic of these arteries owing to their different course.&nbsp;The aim of the study was to study the variation in the formation of renal artery with its branching pattern using CT Angiography.</p> <p>&nbsp;<strong>Methods:&nbsp;</strong>The study was conducted in the department of Radiology at Chitwan Medical College after obtaining ethical approval CMC-IRC. CT Angiogram was studied in 17 individuals who attended radiology department for angiography for different suspected abdominal and renal pathology.</p> <p><strong>Results:&nbsp;</strong>Analyzing the result of the angiography we found the usual branching pattern of renal artery in 70.58% of the individual, with variations in remaining 29.42%. On studying the number of arteries supplying kidney, artery draining directly to hilum i.e. accessory renal artery was 2.95%. We found the average length of right renal artery ranged between 3.5cm to 6.0cm.&nbsp;</p> <p>&nbsp;<strong>Conclusions:&nbsp;</strong>The variations on this large lateral branch of abdominal aorta are common. Surgeons should exclude the possibility of presence of accessory and aberrant renal arteries obstruction prior to the surgical procedure. The awareness about the presence of such variations is important from the academic, surgical and radiological aspect.</p> Ajeevan gautam Gulam Anwer Khan Sameer Timilsina Deepesh Dhungel Sanjib Kumar Sah ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.24472 Attitude, Behavior and Oral Health among Patients Visiting a Dental Institution of Nepal <p><strong>Background: </strong>Majority of oral diseases are related to life style, which means that a behavioral change is needed to reduce the disease. This study was conducted to assess the attitude, behavior and oral health of the patients visiting a dental hospital and association of oral health with age and gender.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted among 130 patients of 15 years and above who visited Kathmandu medical college, Bhaktapur for oral health check-up. Participants were interviewed for their attitude and behavior regarding oral health. Caries experience and periodontal conditions were assessed. Chi square test was done to evaluate the association age and gender with of attitude, behavior and oral health.</p> <p><strong>Results: </strong>In this study, significantly higher number of females went to visit dentist when they noticed bleeding gums than males (p=0.023). Tobacco was consumed more by males than females (p&lt;0.001). Mean DMFT was 3.85±3.035. Bleeding on probing was found in 64.6%; calculus in 18.5% and periodontal pocket of ≥4mm in 11.6%. Loss of attachment of 4mm or more was present in 34.6% and was significantly higher in older age group (p&lt;0.001); in males (p=0.001); who were negligent in visiting dentist (p=0.035); brushed by vertical method (p=0.013) for less than two minutes and more than five minutes (p=0.015); used toothpicks or no interdental cleaning aids (p=0.009); ignored bleeding gums (p=&lt;.001) and who used tobacco products (p&lt;0.001).</p> <p><strong>Conclusions: </strong>This study concluded that the attitude towards the oral health was positive among the patients who visited Kathmandu Medical College, Bhaktapur, Nepal. The oral health behaviour was quite unsatisfactory and needs to be improved.</p> Sirjana Dahal Prakash Poudel Nirrma Khadka Sangita Dahal Manita Acharya Supriya Shrestha Manita Maharjan ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.22630 Relation of Steroid on Linear Growth Velocity with Biochemical Bone Markers in Children with Nephrotic Syndrome in a Teaching Hospital, Central Nepal <p><strong>Background:&nbsp;</strong>Nephrotic Syndrome is the clinical manifestation of glomerular diseases associated with heavy (nephrotic range) proteinuria. This study&nbsp; &nbsp;was done to compare biochemical bone markers in nephrotic children on steroid therapy and the linear growth velocity in children with nephrotic syndrome receiving steroid with that of&nbsp; known available reference standard for children of same age and sex groups</p> <p><strong>Methods:&nbsp;</strong>A hospital based comparative study&nbsp; &nbsp;was conducted in the Department of Pediatrics, College Of Medical Sciences, Bharatpur, Nepal among 40 Study group and 40 Comparatvie group by taking the data from 2014 to 2018.</p> <p>&nbsp;</p> <p><strong>Results:&nbsp;</strong>We found that in study&nbsp; &nbsp;group, the Mean Vitamin D of patients was 12.6293 ± 3.4974 which was low. Present study&nbsp;&nbsp;found that in Study&nbsp; &nbsp;group, the Mean serum Ca (Mean± SD.) of patients was 6.8000 ± .9672. In comparative group, the Mean serum Ca (Mean± SD.) of patients was 9.6907 ± .9218. Difference of Mean serum Ca vs. group was statistically significant (p&lt;0.0001).</p> <p><strong>Conclusions:&nbsp;</strong>We found that the Mean albumin significant lower in study&nbsp; &nbsp;group compared to comparative group but total cholesterolsignificant higher in study&nbsp; &nbsp;group. Vitamin D and calcium were low in Study&nbsp; &nbsp;group which was statistically significant.</p> Atanu Pan Debarshi Jana ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.28302 Neuroendocrine Tumor of Larynx: A Case Report <p>Neuroendocrine neoplasms of the larynx are rare but are the second most common tumors of the region. &nbsp;It is difficult disease to diagnose due to clinical and pathological heterogeneity of the condition. We report a 50 year old non-smoker lady with neuroendocrine tumor of supraglottic region of the larynx who was managed with endoscopic excision of the tumor and had no recurrence till 2 years of follow up.</p> Deepak Paudel Amod Shrestha Shyam Thapa Chettri Bajrang Prasad Sah Paricha Upadhyaya ##submission.copyrightStatement## 2020-03-31 2020-03-31 16 1 10.3126/jcmsn.v16i1.27133