Journal of College of Medical Sciences-Nepal

Description of the Five-day Orientation Program for Enrolling Undergraduate Medical Students for the Academic Year 2022 at Gandaki Medical College in Pokhara, Nepal

Soni Bista, Bijayata Shrestha, Sabita Paudel, Nuwadatta Subedi — Fri, 30 Jun 2023 00:00:00 +0000

Orientation programs for new students are considered beneficial because they aid them as well as the teachers and acclimate them to the learning environment. Additionally, it aids medical students in overcoming various challenges they encounter when adjusting to a new academic setting. Orientation sessions are held in a variety of medical colleges and are widespread worldwide. This paper discusses the five-day orientation program held at the Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal for the newly admitted first-year undergraduate medical students of the 2022 academic year. The institution, teaching-learning activities, respective curricula, and faculty members were introduced to the new students.

Sample Size Estimation in Medical Research Based Upon Study Design

Hari Prasad Upadhyay, Bijay Lal Pradhan — Fri, 30 Jun 2023 00:00:00 +0000

Background: In medical research the target of researcher is to generalize the finding to the population based upon the information of sample data. This sample has to be representative of the target population, and the number of participants must be appropriate. The determination of minimum optimum sample size is extremely important not only for ethical and economic purposes but also to achieve scientifically and statistically sound results and valid conclusion.

Conclusion: Choosing the best study design and calculation of sample size are the most important tool in any research. Before you plan any type of medical research either you should have good knowledge on research methodology or you should meet to professional statistician and ask for help at the time of planning a research project to avoid methodological errors.

Diastolic Function Assessment by Echocardiography at Dhulilkhel Hospital

Sanjaya Humagain, Rajendra Prasad Koju — Fri, 30 Jun 2023 00:00:00 +0000

Introduction
Diastolic dysfunction (DD) is understood as impaired Left ventricular relaxation. Echocardiography is the key in diagnosis. In 2016 recommendation by American Society of Echocardiography(ASE) and the European Association of Cardiovascular Imaging (EACVI) was updated. In our country we do not have a general consensus. Diastolic dysfunction is reported on the basis of E/A ratio of mitral flow, that has the chance of missing a lot of patients with pseudo-normalization. This study carried out to look at importance of evaluation of other parameters to diagnose a patient with diastolic dysfunction.
Methods: It is a retrospective cross-sectional descriptive study. Echocardiography report from the year 2018 and 2019 was collected from database and the patients with diagnosis of Diastolic dysfunction were selected. Patient profile and the echocardiographic parameter were recorded. Echocardiography was reported according to 2016 ASE and EACVI update.
Results: Total of 1982 patients selected for analysis. E/A < 0.8 was seen in 702(35.4%) patients, E/A 0.8- 2.0 was seen in 1136 (57.3%) patients and E/A > 2.0 was found in 144(7.3%) patients. The most common finding being E/e’ 1470 (74.2%) of patients followed by TR velocity > 2.8m/s 1422 (71.7%), Septal e’ velocity < 7 cm/s or Lateral e’ velocity <10 cm/s 1334 (67.3%) and LA area >20 cm2 1286 (64.8%) respectively.
Conclusions: Diastolic dysfunction should be evaluated using all the parameters recommended by 2016 ASE and
EACVI guideline update. Measurement of only E/A ratio has a chance of missing large number of patient with DD.

Assessment of Denture Cleanliness among Complete Denture Wearer in Chitwan

Fri, 30 Jun 2023 00:00:00 +0000

Introduction: Oral cleanliness is important for all to maintain the overall health status. It is also important for the old aged edentulous people with dentures. The complete dentures are custom made device which are the replacement for the missing all tooth of mouth. Many microorganisms adhere to the surfaces of dentures and form denture plaque and calculus. They are there due to inadequate denture hygiene maintenance. This study was performed with the aim of assessing cleanliness of complete dentures among the denture wearers.
Methods :A descriptive cross-sectional study conducted among 140 complete denture in the Department of Prosthodontics and Maxillofacial Prosthetics at Chitwan Medical College and Hospital. A convenience sampling method was used in this study. After taking the sociodemographic information and other information related to dentures, the participants dentures were evaluated with disclosing agent. The stained dentures were then assessed according to the Denture Cleanliness Index. Data was analyzed by using descriptive statistical tools in SPSS-16 and results were presented in form of tables.
Results: The mean age of 140 patients was 71.39±5.80 years. There were 81 (57.9%) females and 59 (42.1) males. About 27 (19.3%) denture wearers did not remove dentures from their mouth at night. Among total, 81 (57.9%) of participants brushed their dentures with water. Denture Cleanliness Index scores of 2 was observed in 64 (45.8%) of denture wearers.

Conclusions: It can be concluded that majority of participants had uncleaned dentures suggesting the need of
proper denture hygiene instructions and routinely follow-up for the cleanliness of dentures and their overall intraoral health status whether or not there were denture stomatitis.

Comparative Study on Postoperative Recovery Profiles of Desflurane and Sevoflurane Using I-GEL in Elective Ambulatory Surgeries

Fri, 30 Jun 2023 00:00:00 +0000

Introduction: In providing general anesthesia for ambulatory surgery, the goal is to achieve optimal surgical conditions while ensuring a rapid early recovery without side effects. Desflurane and sevoflurane are proven as effective ambulatory inhalational anesthetic agents. The aim of this research is to investigate and compared the hemodynamic stability, postoperative outcome and airway responses in elective ambulatory surgeries in patients receiving anesthesia with desflurane or sevoflurane using I-Gel supraglottic airway.
Methods: A prospective, observational study was conducted involving 60 patients of age 18 – 50 years undergoing ambulatory surgeries under general anesthesia, randomly allocated into 2 equal groups receiving desflurane (Group D) or sevoflurane (Group S) for maintenance of anesthesia with suitable size I-Gel. Patients were monitored for hemodynamic parameters and postoperative recovery profile using fast track criteria (FTC) score at different time intervals. Pearson’s Chi Square test and Mann- Whitney U test were used for statistical analysis.
Results: The mean time taken for postoperative recovery characteristics were significantly lower in Group D than Group S (p<0.001).The FTC score was significantly higher (p<0.001) in Group D than Group S at all-time intervals for 30 minutes. The requirement of additional analgesics was 46.7% in Group D and 60% in Group S (p>0.301) and that of antiemetic was 30% in Group D and 26.67% in Group S (p>0.774).
Conclusions: Desflurane showed superior postoperative recovery characteristics and better FTC score without any increase in adverse airway events than sevoflurane.

Clinicopathological Profile of Colorectal Cancers in a Tertiary Care Hospital of Central, Nepal

Fri, 30 Jun 2023 00:00:00 +0000

Introduction
There is an increasing incidence of colorectal carcinoma (CRC) in developing countries like Nepal. The objective of this research is to study the CRC its demography, mode of presentation, type of surgery, complications and Histopathological evaluation (HPE) after surgery.
Methods
This was a retrospective descriptive observational study at College of Medical Sciences, Bharatpur, Nepal. Patients diagnosed with colorectal cancer admitted to gastrointestinal surgery department from July 2019 to June 2022 (3 years) were included. Data of patients were retrieved from hospital records. Pre-operative, intra-operative and post-operative diagnosis of CRC on HPE were also included in the study.
Results
Out of 52 CRC, males were 30 (57.7%) and females were 22 (42.3%), mean age was 52.7 years. Overall, left colon was affected in 33 (63.5%) and right in 19 (36.5%). More than one quarter of patients 14 (26.9%), had disease recurrence by 6 months follow-up. HPE revealed half of the disease condition as adenocarcinoma, moderately differentiated in (50%) cases.
Conclusions
Colorectal cancer is predominant in male patients and older age group. Incidence is high in younger people <40 years and low in extreme age group >80 years. Meticulous surgery is the only proven cure for malignancy.

Knowledge, Attitude, Practice and Barriers Toward Research Among Undergraduate Medical Students

Fri, 30 Jun 2023 00:00:00 +0000

Background:

Early exposure to medical research during undergraduate studies helps to establish a solid medical education by enhancing students' understanding and knowledge of the subject. This exposure also provides valuable experience with evidence-based medicine, which is crucial for success in the medical field. The objective of this study is to assess the knowledge, attitude, practice, and barriers toward research among undergraduate medical students.

Methods:

An analytical cross-sectional study was conducted among undergraduate medical students. Data was collected using a self-structured questionnaire using stratified random sampling. Data was entered and analyzed by using SPSS-20. p-value <0.05 was considered statistically significant.

Results:

The study found that 70.6% of students had good knowledge and 44.9% of students had a good attitude toward research. The good attitude was highest among interns (73.70%) followed by first-year students (60%). The study showed that 28.9% had participated in at least one workshop on research methodology, lab research, or any other similar workshops. Barriers faced by students were lack of time due to the demanding nature of the MBBS curriculum, lack of opportunity to conduct research, lack of funding for research, and difficulty in patient follow-up.

Conclusion:

The students had good research knowledge, with decreasing attitude toward research from first to final year but highest among interns. Research practice among students is low. Barriers faced by students were lack of time, awareness, opportunity; funding, and difficulty in patient follow-up.

Perceived Source of Stress and Associated Stressors among Medical and Dental Students of in a Medical College of Chitwan

Rosina Bhattarai, Anisha Pandey, Prabhas Roy, Sweta K.C — Fri, 30 Jun 2023 00:00:00 +0000

Introduction: Medical and dental students are subjected to high level of stress whether academic, social or health related. Stress in manifested as fatigue, tension, dizziness, inability to fall asleep, irritation, anxiety, suicidal thoughts thereby degrading their quality of life. Therefore, this study was conducted with an objective of assessing perceived stress, stressors and the severity of the stressors.
Methods: A cross-sectional study was conducted among 272 medical and dental students of College of Medical Sciences. Perceived Stress Score (PSS) scale with 10 items questions was used for identifying perceived stress. 32 potential stressors whose severity was rated using Likert scale using score 1 for never/rarely, score 2 for sometimes and score 3 for often/always was used. Ethical clearance was obtained from College of Medical Sciences Teaching Hospital - Institutional Review Committee.
Results: Using mean of PSS score, it was found that 74.26% of the students were stressed. Statistically significant difference was found between gender and stress score. The most frequently occurring academic stressors was reported to be performance in examination (37.9%). Similarly, the most commonly occurring psycho-social stressors was found to be relation with opposite sex (44.5%) which covered the greatest percentage among all stressors.
Conclusions: A large proportion of students in both dental and medical studies are experiencing stress especially on academic and psycho-social aspects. All the stressors must be addressed and students should be taught stress management techniques.

Neutrophils - to - Lymphocytes Ratio and Clinical Outcomes in Patients with Kidney Diseases in COVID 19

Fri, 30 Jun 2023 00:00:00 +0000

Introduction: Kidney Disease is structural and functional abnormality of Nephrons, where abrupt deterioration to progressive decline in Kidney function leads to acute to chronic Kidney Disease, respectively. The objective of this research was to find the Neutrophil-to-Lymphocyte ratio and Clinical outcomes of patients with Kidney Diseases in COVID-19.
Methods: A descriptive cross-sectional study was conducted in the Department of Nephrology of College of Medical Sciences and Teaching Hospital, Bharatpur-10, Chitwan from 2021-04-01 to 2021-06-29 in among 31 Covid-19 positive cases. Collected data was entered and analyzed by using SPSS 20.
Results: In this study 58% were male while 42% were female. Among the total cases 35.48% cases had NRL ratio <8 while 65.52% cases had NRL ratio ≥8. Among total cases 48.38% were discharged whereas, 51.62% were declared dead. Also, among those cases whose NRL ratio <8, 27.27%were declared dead while in NRL≥8, 65% cases were declared dead during treatment.
Conclusions: In Covid-19 cases early diagnosis and supportiv e treatment, prognosis could be good. Regular follow-up could give insight about kidney function whereas in case Covid-19 various awareness programme and practice to prevent should be implied.

Correlation Between Body Fat Composition and Blood Pressure Level Among Medical Students in a Tertiary Care Teaching Hospital In Pokhara, Nepal

Indu Tiwari, Anshu Bhattarai , Poonam Karmacharya , Preetu Gurung — Fri, 30 Jun 2023 00:00:00 +0000

Introduction
Increase in body fat is a common finding in young adults due to sedentary lifestyle and unhealthy dietary habits predisposing an individual to increase in blood pressure which is a common cause of cardiovascular morbidity and mortality. This study aimed to determine the association between body fat composition and BP level in young adults.
Methods
A cross sectional study was conducted among 350 students of Manipal College of Medical Sciences from January to June, 2020. A structured proforma was used to collect the required information about the subjects and measurement of height, weight, waist and hip circumference, BP was done following standard methods. Body fat percentage was assessed by skinfold thickness.
Results
The prevalence of were overweight and obesity was found to be 35.14%. Systolic, diastolic and combined hypertension was found in 64.7%, 53.26% and 57.64% respectively, in overweight and obese population. Increase in body fat percentage in boys and increase in waist hip ratio in girls showed no correlation with increase in systolic, diastolic and mean arterial pressure. However, increase in BMI was strongly correlated (p<0.05) with increase in all the measures of blood pressure- systolic, diastolic and mean arterial pressure.
Conclusions
Body mass index is a better predictor of increased blood pressure level than body fat percentage and waist hip ratio.

Pre-Malignant Lesions of Cervix in Female Attending a Tertiary Hospital of Nepal

Fri, 30 Jun 2023 00:00:00 +0000

Introduction: Cervical cancer is killing Nepali women in gross even though cervical cancer is preventable with time-tested screening strategies in Nepal. Detection of premalignant lesions of cervix is preliminary step for early treatment and to minimise the tragedy of death. The aim of this research is to corelate the Pap smear, colposcopy and guided biopsy findings with histopathology to detect premalignant lesion of cervix.
Methods: A prospective observational study conducted among 145 women attending gynaecology OPD with symptoms during reproductive age 21-65 years. Collection of Pap smear was conducted by conventional method, colposcopy and guided biopsy in selected women were performed and the sample was sent to pathology department for histopathological confirmation.
Results:The pre-malignant lesions in cytology were ASCUS (Atypical Squamous Cells of Undetermined Significance) 11%, ASC-H (Atypical Squamous cell- cannot exclude High Grade)1.3 %, LSIL (Low Grade Intraepithelial Lesion)28.2 %, and HSIL (High Grade Intraepithelial Lesion) 7.5 %. The colposcopy detected 54.4% atypical transformation zone. The histopathology detected Cervical Intra-epithelial Neoplasia I (CIN I) 26.1%, CIN II 11.7%, and CIN III 7.5%. The sensitivity of Pap smear and colposcopy was 83%, the specificity of Pap smear was 88%, and colposcopy was 98%.
The positive predictive value(PPV)were 89% and 98 %, negative predictive value(NPV) were 81%and 83%.and accuracy was 88 % and 98% in Cytology and Colposcopy.
Conclusions:Pap smear and colposcopy were effective tools to detect premalignant lesions of cervix in comparison to histopathological findings.

Utilization of Postnatal Care Services among Mothers Residing in Morang District, Nepal

Fri, 30 Jun 2023 00:00:00 +0000

Introduction: Post-natal care is regarded as the care provided to the mother and the baby during first six weeks of childbirth. Large proportion of maternal and neonatal deaths occur during postnatal period. The utilization of postnatal care services helps in preventing maternal and neonatal deaths. The study aim to find out the utilization of postnatal care services among postnatal mothers residing in Morang district, Nepal.
Methods: A Cross sectional study was undertaken among 256 postnatal mothers residing in Kanepokhari rural municipality, Belbari and Sundarharaincha municipality of Morang district. Multi stage sampling method was used. Ethical approval was obtained from PUSHS- Institutional review committee (Ref no 041—078/079). Face to face interview was done using self developed semi structure questionnaire to collect the data. Descriptive statistics were performed and chi –square was done. Multivariable logistic regression was done
Results: Nearly half (47.3%) had utilized the postnatal care services. Very few (6.6%) of the respondents were aware about the importance about the PNC utilization. Most (85.2%) of the respondents were unaware about the government protocol of PNC visit. Educational level, duration of stay at hospital parity, danger sign seen in pregnancy, place of delivery and mode of delivery were associated with having utilization of postnatal services. The primi mothers (95% CI: 1.229-0.403) had higher likelihood of having postnatal care utilization.
Conclusions: Nearly half postnatal mothers have utilized the postnatal care services. Awareness programme focusing on government protocol for postnatal services should be done to improve the utilization.

Awareness, Attitude, Facilitators, and Barriers of Continuing Professional Development among Nurses Working in Tertiary Care Hospitals of Chitwan

Hem Subba, Sunita Poudyal, Ramesh Subba, Goma Devi Rai — Fri, 30 Jun 2023 00:00:00 +0000

Introduction: Continuing professional development is one of the vital aspects of maintaining up-to-date
knowledge and skills among nurses in health care settings to provide standard patient care. This study's aim was to find out the awareness, attitude, facilitators, and barriers of continuing professional development among nurses.
Methods: A descriptive, cross-sectional study was conducted among 287 nurses working in three different
hospitals in Bhartpur, Chitwan. Structured, self-administered questionnaires were used to gather data within the three-month period. The data were analyzed using descriptive statistics.
Results:More than fifty percent of the respondents had high level of knowledge and attitude toward continuing professional development, and 77% had participated in CPD activity. CPD enhances professional development (76.9%), knowledge improves skills at work (76.9%), and sponsorship by the organization (55.2%) were considered the key facilitators, while understanding the entire program (73.8%), a shortage of staff (69.7%), not being available for all staff (68.3%), a lack of organizational support (63.3%), and a lack of commitment (63.3%) were the major barriers to CPD participation.
Conclusions: This study found that less than half of the nurses were unaware and low level of attitude towards
CPD. One-third of nurses were not involved in CPD activity. So it is important that the all nurses should participate in the CPD program, which will help to update nurses’ knowledge and skills.

Knowledge of Nurses towards Post-exposure Prophylaxis for HIV infection at a Tertiary Health Care Center

Sirjana Shrestha — Fri, 30 Jun 2023 00:00:00 +0000

Introduction
Acquired immunodeficiency syndrome is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus in which progressive failure of immune system allows life threatening opportunistic infection and cancer to thrive. Post exposure prophylaxis is preventive medical treatment recommended immediately after exposure to a pathogen. The objective of this research is to assess the level of knowledge regarding PEP of HIV among nurses.
Methods
An analytical cross sectional study was conducted among 164 nurses to assess the knowledge regarding PEP of HIV among nurses at the College of Medical Sciences and Teaching Hospital, Bharatpur. Data was collected using probability random sampling using self-structured questionnaire. Data was entered and analyzed using in statistical package for social science (SPSS) version 23 using descriptive and inferential statistical tools.
Results
Among the 164 nurses, more than half (56.1%) were in the age 20-25years and had completed their PCL Nursing. Likewise, 35.4% had 2-4 years of experience. Also, 55.5% had a moderate level of knowledge, 18.9% had an inadequate level and 25.6% had adequate knowledge of PEP of HIV. The result of mean ± SD of knowledge was 11.18±3.125. There is statistically significant association between levels of knowledge with working area and total working experience.
Conclusions
The study shows that only 25.6% had adequate knowledge regarding PEP of HIV. Therefore, nurses should be up to date with their knowledge; engage in workshop and training programs periodically.

Successful Pregnancy Outcome in Uterus Didelphys: A Rare Case Report

Sharmila Poudel — Fri, 30 Jun 2023 00:00:00 +0000

Didelphys uterus is a mullerian duct anomaly that is extremely rare and has unpredictable reproductive and gestational effects. Common genital tract congenital defects in women can have a wide range of implications. While some mullerian anomalies are easy to spot, others manifest in odd ways that make diagnosis and treatment difficult. For a thorough grasp of the pathophysiology and clinical characteristics of congenital defects, one should have a solid foundation in fundamental embryology. Uterus didelphys make up 8% of all congenital problems affecting the female reproductive system. About 0.3% of the population is affected. 2.1% of the population of women with a history of infertility and abortion experience this more frequently. This is a case report of a 19 years primigravida mother with uterine didelphys with the outcome being successful delivery with a live female via caesarian section at 32 weeks of gestation.

Keywords: Didelphys uterus; Mullerian duct anomaly; Successful pregnancy.

An Intrauterine Complete Perineal Tear in a Female Neonate, A Rare Birth Injury Related to Breech Presentation: A Case Report

Fri, 30 Jun 2023 00:00:00 +0000

Birth injuries are wounds that a newborn receives when being delivered, whether vaginally or via lower segment caesarean section. It is a case of a 39-week pregnant female with foetal distress and breech presentation in labour who was received in the emergency labour room as a referral case after multiple per vaginal examinations done by a staff nurse at a peripheral hospital, with a complaint of leaking and bleeding per vaginum since then. Her emergency LSCS was done in view of foetal distress with breech presentation. A female baby was extracted and found to have a complete perineal tear in an otherwise healthy neonate. Her paediatric surgeon's opinion was
sought, and a complete perineal tear was done in layers with Vicryl 3-0 sutures. On follow-up, the female neonate was continent and thriving well. Unintended vaginal examinations during breech presentation could result in an intrauterine complete perineal tear if the examiner is untrained. If these injuries are identified immediately and prompt management is done, it may lead to lesser morbidity and a better quality of life.