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 Clinicopathological Study of Ovarian Masses in Adolescent Girls and Young Women in a Tertiary Care Hospital <p><strong>Introduction</strong><br />Ovarian masses include both neoplastic and non-neoplastic lesions. Fortunately, though most ovarian masses in adolescents are benign, about 10% turn out to be malignant. Thus, ovarian tumours constitute an important part of paediatric oncology and often create diagnostic dilemmas. The present study aimed to calculate the frequency and clinicopathological patterns of ovarian masses in adolescent and young females and briefly discuss and compare with the existing literature.<br /><strong>Methods</strong><br />This was a retrospective study conducted at the Department of Pathology of a tertiary care hospital in West Bengal, India. All tissue samples of ovarian masses received in the Pathology department between 10 to 20 years of age group over 6 years (January 2016-December 2021) were included in this study. We evaluated the clinicopathological parameters of the cases. The statistical analysis was performed using Epi Info 7 software.<br /><strong>Results</strong><br />A total of 53 cases were included in present study of the defined age group over 6 years (January 2016 – December 2021), of which 2 had bilateral lesions, so a total of 55 ovarian masses were studied. Of 55 ovarian masses, 50 (90.9%) were benign tumours or non-neoplastic lesions and 5 ovarian masses (9.1%) were malignant. Mature cystic teratoma was the most common type of tumour in this age group.<br /><strong>Conclusions</strong><br />Ovarian masses in perimenarchal and young adults show diversity in the histological spectrum. Although most are benign, early diagnosis preserves fertility in this tender age group.</p> Soumya Kundu Aditi Bhattacharyya Sumit Nandy Pamela Nayak Arpita Bala Copyright (c) 2023 Soumya Kundu, Aditi Bhattacharyya, Sumit Nandy, Pamela Nayak, Arpita Bala 2023-10-17 2023-10-17 19 3 251 258 10.3126/jcmsn.v19i3.45060 Prevalence and Variations of Maxillary Labial Frenal Attachment among the Patients in a Tertiary Health Care Center: An Analytical Cross-sectional Study <p><strong>Introduction</strong><br />A high frenal attachment can cause diastema, distend the gingival sulcus, increasing plaque accumulation, gingival recession, bone loss, poor lip mobility while smiling and speaking, along with speech and esthetic issues. The objective of this study was to assess the prevalence of maxillary labial frenum and its’ variations among patients visiting a tertiary care hospital.<br /><strong>Methods</strong><br />This analytical cross-sectional study was conducted from July 2022 to March 2023 among 385 patients. The demographic details of the participants were recorded and the types of frenal attachment and its’ morphological variations were assessed using the classification by Mirko et al. and Sewerin. Pearson Chi-square test was used to determine the association between categorical variables where p-value ≤0.05 was considered statistically significant.<br /><strong>Results</strong><br />The most prevalent frenum was found to be gingival 237(61.56%) while the least common was papillary penetrating type 29(7.53%). Only 85(22.08%) frenum showed morphological variations where, commonest variation was frenum with nodule 51(13.25%) followed by frenum with appendix 27(7.01%). The gingival frenal attachment was found to be more among younger patients while papillary and papillary frenal attachment were seen lesser among older individuals.<br /><strong>Conclusions</strong><br />Gingival type was the commonest frenal attachment followed by mucosal, papillary and then papillary penetrating frenum in all the age groups and both sexes. Around three-fourth of the participants showed no variations in frenal morphologies.</p> Rebicca Ranjit Soni Bista Suraksha Subedi Pratik Manandhar Narayan Sharma Lamichhane Copyright (c) 2023 Rebicca Ranjit, Soni Bista, Suraksha Subedi, Pratik Manandhar, Narayan Sharma Lamichhane 2023-10-17 2023-10-17 19 3 259 265 10.3126/jcmsn.v19i3.58462 Relationship of Dermatoglyphics with Dental Caries among Pre-School Children- A Hospital Based Study <p><strong>Introduction</strong><br />Dermatoglyphics is the study of the intricate dermal ridge patterns on the skin covering the palmar and plantar surfaces of hand and feet. The basis of considering dermatoglyphic patterns as genetic marker for dental caries is that the epithelium of finger buds as well as enamel has ectodermal origin, and both develop at the same time of intrauterine life.<br /><strong>Methods</strong><br />This study was conducted to examine the relationship ofdermatoglyphics with dental caries among 310 childrenaged 2-6 year old in a private dental hospital in Kathmandu, Nepal. The prevalence of caries was recorded using “Dentition status and treatment needs” (WHO basic oral health assessment form, 1997). They were divided into three groups as follows: Group I (dmft score =0–2), Group II (dmft score = 3–4) and Group III (dmft score ≥5). Black duplicating ink was used to record finger prints (both right and left hand) of all the subjects .The frequency of occurrence of type of dermatoglyphic pattern on fingertip of each digit was noted.<br /><strong>Results</strong><br />No statistically significant association was seen between dermatoglyphic pattern and dental caries in right hand. Statistically significant association was seen between dermatoglyphic pattern and dental caries in 3rd digit of left hand (P-value &lt;0.05).<br /><strong>Conclusions</strong><br />Dermatoglyphics serves as a diagnostic tool in predicting dental caries at an early age and hence preventive treatment strategies can be planned.</p> Priyanka Shah Sanskriti Khanal Copyright (c) 2023 Priyanka Shah, Sanskriti Khanal 2023-10-17 2023-10-17 19 3 266 276 10.3126/jcmsn.v19i3.49866 Risk Assessment of Sudden Cardiac Death in Patients with Atrial Fibrillation Using CHA2DS2-VASc score <p><strong>Introduction</strong><br />Probability of sudden cardiac death is more in patient with atrial fibrillation than those without this condition. CHA2DS2-VASc score can be useful to predict the likelihood of sudden cardiac death among the patients with atrial fibrillation. The current study aims to evaluate the diagnostic value of the CHA2DS2-VASC score in anticipating sudden cardiac death among admitted patients with atrial fibrillation.<br /><strong>Methods</strong><br />The study was conducted for three months i.e. from 16th May 2023 till 17th August 2023. In this research 150 patients fulfilling inclusion criteria were taken. Patient details, ECG features and risk factors were evaluated. CHA2DS2-VASc score was determined and the findings were analyzed statistically.<br /><strong>Results</strong><br />The study population constituted 60% males and 40% female with mean age of 58.9±10.99. The mean CHA2DS2-VASc score was 3.2±2.8. 25.3% of patients with atrial fibrillation had sudden cardiac death. For prediction of sudden cardiac death, CHA2DS2-VASc score had a sensitivity of 78.3%, specificity of 82.3%, positive predictive value of 59.1%, negative predictive value 92% and a diagnostic accuracy of 81.3% for predicting risk of sudden cardiac death.<br /><strong>Conclusions</strong><br />The diagnostic accuracy of the CHA2DS2-VASc score was 81.3% among patients having atrial fibrillation for predicting sudden cardiac death, making it an effective predictor.</p> Manoj Shrestha Bibek Luitel Copyright (c) 2023 Manoj Shrestha, Bibek Luitel 2023-10-17 2023-10-17 19 3 277 281 10.3126/jcmsn.v19i3.58410 Prevalence of Dental Caries among School Going Children in Dolakha, Nepal <p><strong>Introduction</strong><br />There is a significant prevalence and morbidity of dental caries due to a lack of health education and insufficient preventive measures and the health status of students is not satisfactory. A number oforal disorders are linked to chronic diseases, and poor oral health has a major negative impact on overall health. People's everyday lives and general well-being are significantly impacted by pain, issues with eating, chewing, smiling, and communication brought on by missing, discolored, and damaged teeth. The aim of the study was to assess dental caries status among age groups, 3-14 years based on government and private schools.<br /><strong>Methods</strong><br />A cross-sectional comparative study done among 377 school going students age 3-15 years. Children from both private and public schools were included in the study. Dental caries status was assessed using the WHO oral health assessment form for children 2013.<br /><strong>Results</strong><br />The overall caries prevalence among the study participants was 341 (90.2%). Dental caries varied among age groups. Males scored higher dental caries levels than females. The private school students (5.78 ± 4.69) showed significantly higher levels of dental caries than the government school students (5.01 ±4.61).<br /><strong>Conclusions</strong><br />The caries prevalence is very high in the school children of Dolakha with the highest burden among middle childhood age group with high number of untreated caries which emphasizes the need for further intervention.</p> Swagat Kumar Mahanta Dilip Prajapati Anisha Khadka Snehashish Ghosh Usha Ghimire Shirshak Shahi Alina Khimbaja Copyright (c) 2023 Swagat Kumar Mahanta, Dilip Prajapati, Anisha Khadka, Snehashish Ghosh, Usha Ghimire, Shirshak Shahi, Alina Khimbaja 2023-10-17 2023-10-17 19 3 282 287 10.3126/jcmsn.v19i3.54900 Prevalence of Iron Deficiency Anemia among Under Five Years Children in a Tertiary Health Care Center of Nepal <p><strong>Background<br /></strong>Globally 39.8% children under five years old are anemic, with prevalence of childhood anemia in Nepal reported to be 52.7% by 2016. The aim of this study is to analyze the prevalence of anemia among pediatric age group between 2 months to 60 months to provide some insight for prevention of anemia among children.</p> <p><strong>Methods<br /></strong>This is a prospective observational cross-sectional study conducted over the period of 15<sup>st</sup> March 2019 to 14<sup>th</sup> August 2019 at Nobel Medical College Teaching Hospital which included children presenting to pediatric department between ages 2 to 60 months. Children with known history of hemolytic disorders, malignancies and chronic diseases were excluded from the study. Hemoglobin level and Mean Corpuscular Volume (MCV) was obtained. Descriptive statistics such as mean, percentage and standard deviation were calculated.</p> <p><strong>Results<br /></strong>Total 500 children selected randomly for the study, 234 (46.8%) children were non-anemic while mild anemia was seen in 86 (17.2%), moderate anemia in 155 (31.0%) and severe anemia in 25(5.0%) children. Mean hemoglobin was 10.2 gm/dl with standard deviation of 1.847. Among male 45.6% were anemic whereas 42.7%female were anemic. Children of age group 2 to 12 months had higher percentage of anemia with 76.2% being anemic. Among 266 anemic children 219 (82.3%) had MCV below the normal range.</p> <p><strong>Conclusion<br /></strong>Our study shows the higher prevalence of anemia in children between 2 to 60 months of age. Microcytic anemia was more common which represents higher prevalence of iron deficiency anemia among anemic children.</p> Babita Khanal Sandip Pokhrel Sandip Kumar Singh Sunil Kumar Yadav Prakash Kafle Copyright (c) 2023 Babita Khanal, Sandip Pokhrel, Sandip Kumar Singh, Sunil Kumar Yadav, Prakash Kafle 2023-10-17 2023-10-17 19 3 288 293 10.3126/jcmsn.v19i3.55954 Clinical Profile of Children with Thalassemia Admitted for Blood Transfusion at a Tertiary Health Care Center <p><strong>Introduction</strong><br />Thalassemia is a prevalent hereditary hematological disorder that is characterized by a reduction or absence of globin chain synthesis. The objective of this study is to determine the clinical profile of children with thalassemia who undergo repeated packed cell transfusions.<br /><strong>Methods</strong><br />A prospective cross-sectional observational study was conducted from January 1, 2023, to May 31, 2023, in the Pediatric ward at Bharatpur Hospital. Ethical clearance was obtained from the Institutional Review Committee of Bharatpur Hospital (Ref: 078/79-018). A total of 53 cases of Thalassemia, who were receiving regular blood transfusions, were included in this study.<br /><strong>Results</strong><br />The prevalence of thalassemia was 3.68% (with 95% CI 2.7% to 4.65%). The average age at diagnosis was 15.58 months, with a range of 2 to 97 months. The majority of cases, 32 (60.37%), were diagnosed before the age of one year, with a male-to-female ratio of 1.2:1. Thalassemia was more prevalent in the Tharu community (58.5%) compared to other communities.</p> <p><strong>Conclusions</strong><br />Thalassemia is a hematological disorder that predominantly affects the Tharu community. Common clinical manifestations of transfusion-dependent thalassemia in children include pallor, hepatomegaly, splenomegaly, and facial deformities. Therefore, it is imperative to monitor serum ferritin levels to detect iron overload early and initiate chelation therapy promptly to prevent complications. Such measures can significantly improve the quality of life of affected individuals and reduce the burden of this genetic disorder on affected communities.</p> Damodar Tiwari Sweta Kumari Gupta Narayan Bahadur Thapa Kiran Devkota Copyright (c) 2023 Damodar Tiwari, Sweta Kumari Gupta, Narayan Bahadur Thapa, Kiran Devkota 2023-10-17 2023-10-17 19 3 294 298 10.3126/jcmsn.v19i3.56520 Facial Height and Its Effect by Tooth Wear, Age and Sex Assessed By Soft Tissue Analysis <p><strong>Introduction</strong><br />Tooth wear is one of the major and widely accepted problem nowadays. It is the loss of dental hard tissues by these processes: attrition, abrasion and erosion. It can occur due to various factors such as abnormal tooth contact, abrasive dental hygiene habits and erosive dietary factors.<br /><strong>Methods</strong><br />Full face photographs of each subject was taken from the frontal view with a natural head position guided to true horizontal in 66 sample. All photographs were evaluated for consistency in head position and picture quality. Total facial height was subdivided into two components: upper facial height and lower facial height. Measurements of UFH and LFH and their ratio were recorded. Also tooth wear was assessed on a tooth-by-tooth basis rated according to the 5-point ordinal scale (0-4). All the data was statistically analyzed by SPSS.<br /><strong>Results</strong><br />Statistically significant difference was found between Lower Facial Height and age group (p-value=0.02) whereas there was no statistically significant difference between UFH and RUL with age group. UFH and LFH was found to be slightly higher in females than males, however, on application of independent t-test it was found that there were no statistically significant differences between gender and facial height (p-value &gt; 0.05). Weak negative correlation was found between facial height, age and tooth wear (r=-0.24, p-value 0.052 and r-value =-0.28, p-value 0.023).<br /><strong>Conclusions</strong><br />Facial height decreases with increase in age. Upper facial height is slightly greater than lower facial height with tooth wear.</p> Anisha Pandey Rosina Bhattarai Suraksha Shrestha Copyright (c) 2023 Anisha Pandey, Rosina Bhattarai, Suraksha Shrestha 2023-10-17 2023-10-17 19 3 299 306 10.3126/jcmsn.v19i3.56117 Spectrum of Lesions in the Urinary Bladder: A Histopathological Study in a Tertiary Level Hospital <p><strong>Background: </strong>Urinary Bladder cancer is the 7<sup>th</sup> most common cancer worldwide, with an estimated 260,000 new cases occurring each year in men and 76,000 in women. 90% of the bladder tumors are of urothelial origin. Cystoscopic examination has a limited role in staging process for which transurethral resection (TURBT) of visible tumor down to the base is required which can accurately assess depth of tumor invasion.</p> <p><strong>Aim &amp; Objectives:</strong> The aim is to study the spectrum of urinary bladder lesions according to World Health Organization / International Society of Urological Pathology consensus classification and to determine age and sex distribution of urothelial tumors.</p> <p><strong>Material &amp; Method:</strong> Study included 55 TURBT specimens, conducted over a period 12 months, extending from January 2022 to December 2022. Hematoxylin &amp; Eosin (H&amp;E) stained sections were examined for morphologic diagnosis of urothelial lesions.</p> <p><strong>Results:</strong> In our study, there was male preponderance with ratio of 3.2:1. Among 55 cases studied, 34.55% cases were diagnosed as invasive urothelial carcinoma, 27.27% cases were of non-invasive urothelial carcinoma, 16.36% cases were of benign urothelial neoplasm and 16.36% cases were of non-neoplastic lesions in urinary bladder. There were also 1.82% cases of adenocarcinoma, metastasis and non-diagnostic each in our study. Amongst invasive carcinoma high grade were encountered most (30.91%) cases. Maximum numbers of urothelial neoplasms (25.45%) were seen in 71-80 years of age group.</p> <p><strong>Conclusion:</strong> This study revealed that neoplastic lesions are more common than non-neoplastic lesions. Urothelial tumors are seen commonly in seventh decade with overall male predominance. Also this study, documents a high frequency of invasive than non-invasive type of urothelial neoplasm.</p> Suman Poudel Sunita Ranabhat Sharmila Shahi Gita Pun Copyright (c) 2023 Suman Poudel, Sunita Ranabhat, Sharmila Shahi, Gita Pun 2023-10-17 2023-10-17 19 3 307 312 10.3126/jcmsn.v19i3.57897 Clinical Profile and Outcome of Acute Pancreatitis in a Tertiary Health Care Center of Nepal <p><strong>Introduction</strong><br />Acute pancreatitis is the inflammation of pancreatic parenchyma that can cause local and systemic manifestations. This study aimed to find the clinical profile and an outcome of acute pancreatitis among patients attending the Department of Gastroenterology in a tertiary care center.<br /><strong>Methods</strong><br />A cross-sectional hospital based study comprising of 75 patients of acute pancreatitis, enrolled between August 2022 to June 2023. Clinical profile, complications and outcomes including in hospital mortality were studied. Revised Atlanta classification and modified CT severity index were used for diagnosis and classification. Data entry and analysis were done SPSS-17.<br /><strong>Results</strong><br />Most common age group was 40-60 years (50.7%). The most common etiology was alcohol (46.7%) and almost all presented with abdominal pain (97%) and abdominal tenderness was present in 80%. Majority were mild pancreatitis (54.7%), followed by moderately severe (32%) and severe pancreatitis (13.3%). Factors that are significantly associated with prolonged stay at hospital and mortality were pleural effusion, necrotizing pancreatitis, acute kidney injury, BISAP score ≥ 2, high total leucocyte count, shock, severe CT severity score, multi organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS)(p≤0.05).<br /><strong>Conclusions</strong><br />Acute pancreatitis is predominant in male gender and 40-60 years age group. It is associated with significant complications and mortality. Different parameters including high BISAP score, pleural effusions, acute kidney injury, leucocytosis and high CRP level on presentation were useful markers to predict outcome.</p> Ajay Kumar Gautam Khus Raj Dewan Rishab Shrestha Vijaya K.C. Copyright (c) 2023 Ajay Kumar Gautam, Khus Raj Dewan, Rishab Shrestha, Vijaya K.C. 2023-10-17 2023-10-17 19 3 313 319 10.3126/jcmsn.v19i3.57068 Analysis of Liver Function Test in Common Bile Duct Stone: A Descriptive Cross sectional study <p><strong>Introduction: </strong>Liver function test (LFT) is a useful tool to differentiate between the obstructive and hepatocellular cause for biliary obstruction. Therefore this study was done to see the accuracy of LFT in predicting common bile duct (CBD) stones.</p> <p><strong>Methods: </strong>A descriptive cross sectional study was carried out on patient undergoing endoscopic retrograde cholangiopancreatography for CBD stones at Bharatpur Hospital and Dev Hospital from 2021 June 15 to 2022 October 15. Ethical clearance was taken from Institutional Review Committee Bharatpur Hospital reference number 079/80-013. The convenient sampling method was applied. Data were collected and analyzed in statistical package for the social sciences version 22.</p> <p><strong>Results: </strong>Out of 95 patients higher aged female predominance was seen. The overall incidence of abnormal LFT in CBD stones was 85.3%. All the parameters of LFT were raised in majority of the cases of CBD stones and among these, SGOT was mostly increased (75.6%). In patients with ERCP findings of sludge in bile duct have increased total, direct and indirect bilirubin than in patient with CBD stone and this finding was found to be statistically significant. However, other liver parameters were comparable.Similarly, total, direct and indirect bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase (ALP) were equally raised with both group of CBD stones with and without cholecystitis.</p> <p><strong>Conclusion: </strong>Liver function test was equally raised in both case of CBD stone with and without cholecystitis. Although ALP and total bilirubin represented the most reliable predictors in obstructive jaundice, SGOT might also be added tool to exclude choledocholithiasis.</p> Ashis Pun Amit Dhungana Ronit Kumar Shrestha Hari Prasad Upadhyay Copyright (c) 2023 Ashis Pun, Amit Dhungana, Ronit Kumar Shrestha, Hari Prasad Upadhyay 2023-10-17 2023-10-17 19 3 320 325 10.3126/jcmsn.v19i3.58581 Student’s Knowledge and Practices on Basic School Health Services in Relation to School Health Nurse Program <p><strong>Introduction</strong><br />Basic school health services (BSHS) provided by the school nurse have the potential to significantly reduce the prevalent preventable health issues at school community. The objective of this study was to assess the of students on basic school health services in relation to school health nurse program. To assess the Students Knowledge and Practices on basic school health services in relation to school health nurse program<br /><strong>Methods</strong><br />An analytical cross-sectional study conducted among 313 students on basic school health services in schools with and without implementation of school health nurse program using a non-probability purposive sampling technique. Data were collected using a self-administered questionnaire and an observation check list, and analyzed using descriptive and inferential statistics.<br /><strong>Results</strong><br />There is statistically significant difference in mean score of knowledge among students with School Health Nurse Program (SHNP) and not having school health nurse program. The practice of basic school health was significant association on how at comfort students felt when dealing with health issues (p&lt;0.001), providing first aid and emergency care (p&lt;0.001), conducting screening programs (p&lt;0.001), distribution of free iron and deworming tablets (p&lt;0.001), and engaging in physical activity (p&lt;0.001).<br /><strong>Conclusions</strong><br />Implementation of school health nurse program has positive impact on basic school health program in schools. Students' knowledge and practice regarding school health services found higher in SHNP-implemented schools than in SHNP-non-implemented schools. Thus, study suggest that the basic school health program's implementation in schools is influenced by the school health nurse program.</p> Jiwan Kumar Poudyal Trishna Sharma Sumitra Parajuli Hari Prasad Upadhyay Copyright (c) 2023 Jiwan Kumar Poudyal, Trishna Sharma, Sumitra Parajuli, Hari Prasad Upadhyay 2023-10-17 2023-10-17 19 3 326 336 10.3126/jcmsn.v19i3.58591 Outcome of Surgical Management of Ipsilateral Femur and Tibia Fracture: The Floating Knee Injury <p><strong>Introduction</strong><br />Floating knee injuries are one of the rare injuries of the lower limb involving fracture of ipsilateral femur and tibia. These injuries are often associated with other systemic injuries and have higher incidence of morbidity and mortality. Often times these fractures can pose difficulty in achieving union and might have residual stiffness around the knee. This study was carried out to assess the functional and radiological outcome of surgical management of floating knee injuries and the associated complications.<br /><strong>Methods</strong><br />A hospital based prospective study including 34 cases of surgically managed floating knee injuries over a period between January, 2017 and December, 2019 with the mean follow-up duration of 15 months was performed. The final outcome was evaluated on the basis of Karlstorm and Orelud criteria.<br /><strong>Results</strong><br />Final analysis was done based on the Karlstorm and Orelud criteria after the bony union was achieved. Based on the Karlstorm and Orelud criteria, 44.11% cases had excellent outcome, 29.41% cases had good outcome, 14.7% cases had a fair outcome and 11.76% cases had a poor outcome.<br /><strong>Conclusions</strong><br />Floating knee injuries are severe injuries often associated with polytrauma. Operative management in these complex injuries can yield favorable functional outcome with fewer complications.</p> Hemant Kumar Gupta Suman Lamichhane Copyright (c) 2023 Hemant Kumar Gupta, Suman Lamichhane 2023-10-17 2023-10-17 19 3 337 344 10.3126/jcmsn.v19i3.58380 Comparative Study of FNAC and Histopathology in Diagnosis of Thyroid Swelling <p><strong>Introduction</strong><br />Fine Needle Aspiration Cytology (FNAC) is important for pre-operative and pre-treatment diagnosis of benign and malignant thyroid lesions, thus decreasing the incidence of unwanted surgeries. The objective of this research is to compare the FNAC and Histopathological findings of thyroid swelling.<br /><strong>Methods</strong><br />The present study is a cross sectional study conducted on 30 patients in the Department of Otorhinolaryngology Head and Neck Surgery, College of Medical Sciences, Bharatpur, Nepal from January 2022 to December 2022. Thyroid swelling presented to OPD were examined clinically after thorough history taking and admitted to indoor and subsequently underwent surgery were included in this study. After Histopathology they were compared with preoperative FNAC report. In all cases, informed consent was taken prior to the surgery.<br /><strong>Results</strong><br />FNAC shows thirteen (28.57%) non neoplastic and twenty-two (71.43%) neoplastic. Among non neoplastic thyroid swelling, colloid goiter was common. Among neoplastic thyroid swelling Papillary carcinoma was the most common. Cyto-histopathological correlation of 35 cases was done. Out of thirty-five cases fifteen (42.87%) were non neoplastic and twenty (57.15%) were neoplastic. Colloid goiter was most common. Sensitivity of our study was 88.24%, Specificity was 55.56 % and accuracy was 71.43%.<br /><strong>Conclusions</strong><br />FNAC is a quick, safe, and reliable first-line diagnostic test for thyroid nodules. However, histopathology is the gold standard for the diagnosis of thyroid cancer and provides detailed information on the tumor size, location, and histological type.</p> Bibek Sharma Alina Baral Apar Pokharel Deepak Jung Subedi Copyright (c) 2023 Bibek Sharma, Alina Baral, Apar Pokharel, Deepak Jung Subedi 2023-10-17 2023-10-17 19 3 345 349 10.3126/jcmsn.v19i3.54039 Effect of Intrathecal Fentanyl on Shivering During Spinal Anesthesia <p><strong>Introduction</strong><br />Perioperative shivering is a common complication following spinal anesthesia. Apart from the obvious discomfort, shivering is associated with a number of potentially deleterious sequels. The objective of this research is to study the effect of intrathecal fentanyl on shivering.</p> <p><strong>Methods</strong><br />Retrospectively two hundred patients were included and divided into two equal groups. In group A, 3.5 ml of 0.5% heavy bupivacaine was mixed with 25 mcg (0.5 ml) of fentanyl to make 4 ml solution out of which the enrolled patients received 3.5 ml of the mixed solution. Group B received 3.5 ml of 0.5% plain heavy bupivacaine. Modified bedside shivering assessment scale was used to score the intensity of shivering.<br /><strong>Results</strong><br />In group A, 16 patients (16%) had severe shivering, 30 patients (30%) had moderate shivering and 46 (46%) had mild shivering. Rest of the patients (8%) did not experience shivering. In group B, all the patients had shivering. Severe shivering was observed in 28 patients (28%), moderate shivering was observed in 62 patients (62%) and mild shivering in 10 patients (10%).<br /><strong>Conclusions</strong><br />Fentanyl as an adjuvant to heavy bupivacaine during spinal anesthesia decreases the incidence and severity of shivering compared to bupivacaine alone.</p> Ajay Singh Thapa Rakesh Sah Rajesh Kumar Yadav Anish Bhattarai Copyright (c) 2023 Ajay Singh Thapa, Rakesh Sah, Rajesh Kumar Yadav, Anish Bhattarai 2023-10-17 2023-10-17 19 3 350 356 10.3126/jcmsn.v19i3.58643 Intradialytic Complications and its Associated Factors Among Chronic Kidney Disease Patients in a Tertiary hospital <p><strong>Introduction</strong><br />Chronic kidney disease is a public health problem affecting millions of people worldwide. Hemodialysis is a life-saving renal replacement therapy for patients with chronic kidney disease(CKD), but it is not without risks. Intradialytic complications, which occur during hemodialysis sessions, can have a significant impact on patients' well-being, treatment outcomes, and overall quality of life. This article aims to identify the intradialytic complications and its associated factors in patients with chronic kidney disease undergoing hemodialysis in a tertiary hospital of eastern Nepal.<br /><strong>Methods</strong><br />An observational cross-sectional study design was employed among 72 patients receiving hemodialysis treatment at Birat Medical College Teaching Hospital from 28 January to 20 May 2023. Total enumeration sampling technique with a structured questionnaire via interview and observation technique was used for data collection. Collected data was entered in Microsoft Excel sheet and transferred to SPSS version 17. Frequency, mean, range, and standard deviation was calculated. Chi square test was used to determine the association. P-value &lt;0.05 was considered<br />statistically significant.<br /><strong>Results</strong><br />All patients undergoing hemodialysis experienced at least one intradialytic complication. The most common complications reported were nausea/vomiting 59(81.9%) and chills/rigor 57(79.2%). Hypoglycemia was observed in 23.6% of patients, hyperglycemia in 12.5%, hypotension in 8.3%, and arrhythmia in 2 patients.<br /><strong>Conclusions</strong><br />Intradialytic complications are common among chronic kidney disease patients undergoing hemodialysis.The associations between age, dialysis frequency, preexisting diabetes, hypertension, and specific complications emphasize the need for individualized care and tailored interventions.</p> Dilip Sah Heera KC Sweta Shah Rabin Rai Copyright (c) 2023 Dilip Sah, Heera KC, Sweta Shah, Rabin Rai 2023-10-17 2023-10-17 19 3 357 366 10.3126/jcmsn.v19i3.55739 Prevalence of Refractive Errors among Under Five Year Children Attending in a Tertiary Eye Care Center of Nepal <p><strong>Introduction</strong><br />Refractive errors are common vision problems that occur when the shape of the eye does not properly bend or refract light to focus it on the retina. The objective of this research was to estimate the prevalence among children under-five years of age in Lumbini, Nepal.<br /><strong>Methods</strong><br />A hospital-based observational study was conducted among children attending the Lumbini Eye Institute and Research Center. Participants were selected over three months using systematic random sampling. Ophthalmic examination with retinoscopy (dry and wet) was used to determine refractive errors. The proportion of children with spherical equivalent myopia ≤-0.50 diopter (D), SE hyperopia ≥+2.00 D and SE astigmatism &gt;0.5 in both eyes were calculated. Prevalence of myopia, hyperopia and astigmatism was reported by age, gender and religion.<br /><strong>Results</strong><br />Among 1,561 recruited children, the prevalence of refractive errors was 15.4% (n=240, 95% CI: 13.6% to 17.3%). The prevalence was significantly higher among older children (3 to 5 years) than the younger children (OR: 4.7; 95% CI: 1.7 to 13.1). Myopia was the most common condition (n=211, 13.5%, 95% CI: 11.9% to 15.3%). Myopia and astigmatism were significantly higher among children 3 to 5 years (22.1% and 5.56% respectively). Hyperopia prevalence was significantly higher among infants (3.3%).<br /><strong>Conclusions</strong><br />The prevalence of refractive errors increased with age that was relatively high among infants and young children.</p> Hari Bahadur Thapa Kabindra Bajracharya Sirshendu Chaudhuri Varun Agiwal Katie Judson Ken Bassett Mahesh Kumar Dev Saraswoti Khadka Hari Prasad Upadhyay Copyright (c) 2023 Hari Bahadur Thapa, Kabindra Bajracharya, Sirshendu Chaudhuri, Varun Agiwal, Katie Judson, Ken Bassett, Mahesh Kumar Dev, Saraswoti Khadka, Hari Prasad Upadhyay 2023-10-17 2023-10-17 19 3 367 377 10.3126/jcmsn.v19i3.55620 Perforated Transverse Vaginal Septum with Primary Infertility: A Case Report <p><strong>Introduction</strong><br />A transverse vaginal septum develops when the canalization of the vaginal plate fails at the intersection of the mullerian duct and the urogenital sinus and It is a rare genital abnormalities in women, with an estimated incidence of 1/70,000 females. Patient with transverse vaginal septum may present with primary amenorrhea, cyclical abdominal pain, haematocolpos, haematometra and infertility. Women with perforated septa may menstruate but have trouble during intercourse. The diagnosis is typically made by a clinical examination together with ultrasound and MRI used for confirmation. We report a case of 24 years female presented with infertility for 5 years diagnosed with perforated transverse vaginal septum managed with resection of septum by hysteroscopy and laparoscopy.</p> Shree Prasad Adhikari Copyright (c) 2023 Shree Prasad Adhikari 2023-10-17 2023-10-17 19 3 378 381 10.3126/jcmsn.v19i3.56629 Repair of Ventricular Septal Defect in a Patient with Hemophilia A: Case Report <p>Hemophilia is an X-linked recessive hemorrhagic disease that affects 1 in 10,000 males worldwide, in all ethnic groups; hemophilia A represents 80% of all cases. Congenital heart disease is the most commonly occurring birth defect; it is formed during the intrauterine period. The combination of these two disease is rather rare and requires the cardiosurgeon’s apprehensive attitude. Here, we present our experience in the surgical treatment of a boy of 1-year-old with Perimembranous Ventricular Septal Defect with Hemophilia A which was found in preoperative examination. He was successfully operated with cardiac pulmonary bypass on the background of factor VIII injection.</p> Sona Sharma Copyright (c) 2023 Sona Sharma 2023-10-17 2023-10-17 19 3 382 384 10.3126/jcmsn.v19i3.58063