Journal of Gandaki Medical College-Nepal <p>An official publication of the Gandaki Medical College Teaching Hospital &amp; Research Centre Pvt. Ltd.</p> <p>Journal of Gandaki Medical College-Nepal (JGMC-N) is indexed in Directory of Open Access Journals (DOAJ), NepJol, NepMed and Google Scholar.</p> en-US <p><span style="font-weight: 400;">This license allows reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator. </span></p> (Dr. Nuwadatta Subedi) (Sioux Cumming) Thu, 20 Jun 2024 08:55:11 +0000 OJS 60 Stethoscopes: A potential source of hospital-acquired infection of methicillin-resistant Staphylococcus aureus <p><strong>Introduction: </strong>The stethoscope, an essential tool for medical examination, can be an important vehicle for the transmission of drug-resistant pathogens like methicillin-resistant <em>Staphylococcus aureus</em>. Thus, this study aimed to detect the stethoscope as a potential source for hospital-acquired methicillin-resistant <em>Staphylococcus aureus </em>infection.</p> <p><strong>Methods: </strong>This descriptive cross-sectional study was carried out from January to February, 2023 in the Department of Microbiology by collecting swab samples from medical interns’ stethoscopes. Ethical clearance from the Institutional Review Committee was obtained (Ref. No. 139/078/079). <em>Staphylococcus aureus </em>were isolated and methicillin resistance was detected using cefoxitin disc following Clinical and Laboratory Standards Institute guidelines. Consecutive nonprobability sampling was used. Data analysis was done using a Statistical Package on Social Sciences version 26.0.</p> <p><strong>Results: </strong>From a total of 103 swabs, 89(86.40%) showed growth, among which 41(46.10%) were identified as <em>Staphylococcus aureus</em>. Out of 41, <em>Staphylococcus aureus </em>identified, 13(31.7%) were methicillin-resistant. Methicillin-resistant strains were mainly isolated from emergency and intensive care units, 3(23.1%). More than fifty percent of the strains were resistant to azithromycin, ciprofloxacin, and ofloxacin. None of the strains were resistant to linezolid.</p> <p><strong>Conclusions: </strong>Detection of methicillin-resistant<em> Staphylococcus aureus</em> on the stethoscope used by medical interns working in critical areas of our institution is of utmost concern. This basic data is an eye opener for vigilance surveillance and practicing of disinfecting stethoscopes and hand hygiene among health workers in health care centers.</p> Sanjib Mani Regmi, Shanti Pradhan, Parajit Singh Bhandari, Sushil Kumar Chaudhary, Gyanendra Gautam, Kripa Ghimire, Sanij Singh, Prabin Shrestha Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Prevalence and outcomes of short birth spacing pregnancy: A cross-sectional study <p><strong>Introduction:</strong> Short birth spacing pregnancies are associated with adverse maternal and fetal outcomes and are highly prevalent in Nepal. The study aimed to establish the prevalence of short birth spacing and observe maternal and neonatal outcomes in those pregnancies in Western Nepal.</p> <p><strong>Methods:</strong> A cross-sectional study was carried out among pregnant women aged 20 to 40 years, visiting Department of Obstetrics and Gynecology, Gandaki Medical College for a period of six months from April through October 2023. Data surrounding demographics, current and previous pregnancy and neonatal outcomes were collected in a structured questionnaire for women included into the short birth spacing group. Descriptive statistics were used to observe the outcomes.</p> <p><strong>Results:</strong> The prevalence of short birth spacing was 18.38%. The participants ranged from 21 to 37 years, mean age being 26.72 years. About half (52.5%) had an inter-delivery interval between 18 and 24 months. About a third women (34%) had fewer than four antenatal visits and over three-fourths (76.25%) of them delivered at term. Vaginal delivery was slightly more common than LSCS (52% vs 48%). Preterm and low as well as very low birth weight of babies were more frequently found in shorter interpregnancy interval group. Though 112(80%) neonates required intensive care service as a part of transitional care or due to sepsis, there were no neonatal deaths.</p> <p><strong>Conclusions:</strong> The prevalence of short birth spacing was comparatively less than the existing data from Nepal. The outcomes would have been better if the patients have frequent antenatal visits and are managed at tertiary care centers.</p> Chandika Pandit, Aachal Barma, Jayaj Adhikari, Devraj Mahato, Mitesh Karn Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Different occlusal schemes in eccentric mandibular positions <p><strong>Introduction:</strong> The alignment of teeth and their occlusal relationship in the arch plays an important role in mandibular movements during static and dynamic positions. Harmonious and synchronized mandibular movements is important for the physiological occlusion during lateral excursions of the mandible. Hence, the present study was designed to determine the different occlusal schemes in eccentric mandibular positions and the frequency percentage of each occlusal pattern was determined.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted among 64 undergraduate students of Gandaki Medical College aged from 18 to 30 years, where, a convenience sampling technique was used for data collection. The occlusal contacts were recorded in 1, 2, and 3 mm from the maximum intercuspal position on both the working and non-working sides. Working side occlusal contacts were determined for the total range of lateral positions and classified into: canine protection, group functions, or others (occlusal patterns other than those described).</p> <p><strong> Results:</strong> Most of the working side contact patterns were classified as group function (66.15%) followed by canine-guided occlusion (18.75%); while contact patterns other than canine protection and group function were found in 15.10% of the contact patterns on the right side. On the left side, group function was found in 62.50%, canine protection in 9.33% and others in 14.67% of the contact patterns.</p> <p><strong>Conclusions:</strong> On laterotrusion, most subjects had group function on the working side but canine protection was found to be rare.</p> Pratik Manandhar, Sapna Laxmi Tuladhar, Neeta Thapa, Rebicca Ranjit Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Comparative study on the efficacy of perineural vs intravenous dexamethasone as an adjunct to bupivacaine to prolong analgesia after axillary brachial plexus block in a tertiary care center, Pokhara <p><strong>Introduction:</strong> In resource-limited settings, adjuvant drugs offer an alternative to extend peripheral nerve block analgesia. This study compared perineural and intravenous dexamethasone for post-operative analgesia in upper limb surgery patients under axillary brachial plexus block.</p> <p><strong>Methods:</strong> An experimental study was done on 60 patients undergoing unilateral upper limb surgery under axillary brachial plexus block, randomized into two groups. Group A received bupivacaine 0.25% 30ml with perineural dexamethasone 8mg, and Group B received the same bupivacaine dose with intravenous dexamethasone 8mg. The duration of analgesia, reported as the time of breakthrough pain at the operative site, was considered the primary outcome. The duration of sensory blockade, VAS scores, and postoperative rescue analgesic consumption were noted. Student’s t-test applied to compare difference in mean between two groups.</p> <p><strong>Results:</strong> In 60 patients (30 per group), group A showed a statistically significant longer duration of analgesia (9.67±0.92 hours) than group B (8.89±0.93 hours) (p=0.002, 95% CI 0.31–1.27). VAS scores at 4 and 8 hours postoperatively were significantly lower in group A (1.20±0.85 and 1.97±0.67) than in group B (1.80±0.85 and 2.60±0.72). Group A also had significantly lower rescue analgesic consumption (4.17±9.48 mg) than group B (12.50±17.06 mg) (p=0.023).</p> <p><strong>Conclusions:</strong> Perineural dexamethasone significantly prolonged analgesia compared to intravenous dexamethasone in patients undergoing upper limb surgery under ultrasonography-guided axillary brachial plexus block.</p> Thaneshwar Pahari, Rozeeta Hirachan, Sandeep Neupane, Kushal Mohan Bhattarai, Praynjal Pakhrin Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Prevalence of type of dental caries among the patients visiting a tertiary health care center in the Western region of Nepal <p><strong>Introduction: </strong>Dental caries is one of the major public health problems globally due to its high prevalence and significant social impact. The objective of the present study was to assess the most prevalent type of dental caries among the studied population.</p> <p><strong>Methods: </strong>This cross-sectional study was conducted among 300 participants. The data were collected by intraoral examination of the subjects, where the type of dental caries in each patient was examined. The surfaces infected with dental caries were recorded as occlusal pit and fissure caries, root caries, smooth surface caries, and recurrent caries. Descriptive statistical methods were applied for data analysis.</p> <p><strong>Results: </strong>The most prevalent type of dental caries was found to be the occlusal pit and fissure caries 595(66.04%) followed by smooth surface caries 220(24.42%), recurrent caries 54(5.99%) and root caries 32(3.55%). The occlusal pit and fissure caries was more prevalent in the mandibular arch 298(67.73%). Males had more prevalence of different types of dental caries. Based on the age group, 40 to 50 years age group had the most prevalent type of occlusal pit and fissure caries 60(20%).</p> <p><strong>Conclusions: </strong>The results showed a high prevalence of occlusal pit and fissure caries in the study population followed by smooth surface caries, recurrent caries, and root caries. </p> Babita Pradhan, Deepa Kunwar, Rebicca Ranjit, Namrata Gyawali Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Prevalence and determinants of acute respiratory infections among under-five children in a tertiary care center at Pokhara, Nepal <p><strong>Introduction:</strong> Acute respiratory infection (ARI) is a major determinant of morbidity and mortality among under-five children in developing countries. Despite decreasing trends in childhood morbidity and mortality, ARI remains a significant predictor of recurrent illness and hospitalization among under-five children in Nepal. This study was conducted to assess the prevalence and determinants of ARI among under-five children at a tertiary care center at Pokhara, Nepal.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted among 358 mother-child dyads who were recruited through a purposive sampling technique and data was collected through the computer-assisted personal interview (CAPI) technique. Descriptive and inferential statistics were used. The level of statistical significance was set at p&lt;0.05.</p> <p><strong>Results:</strong> The prevalence of ARI among under-five was 39.38%. The age of the child (AOR=8.37, 95% CI:5.00–13.99), being male (AOR=3.13,95% CI: 2.00–4.86), mother’s education below secondary level (AOR=2.28, 95% CI:1.39–3.73), child with no EBF (AOR=1.86, 95% CI:1.21–2.86), stunted child (AOR=2.99, 95% CI: 1.93–4.64), wasted child (AOR=2.66, 95% CI:1.71–4.12), passive smoking by child (AOR=2.43, 95% CI: 1.49–3.97), having no separate kitchen (AOR=0.18, 95% CI: 0.11–0.29) were found to be significant determinants of ARI.</p> <p><strong>Conclusions:</strong> More than 1/3rd of the under-five children had ARI. Age and gender of the child, maternal education, breastfeeding and nutritional status of the child, passive smoking, not having a separate kitchen, and using wood as a cooling fuel were the determinants of ARI among under-five children. The occurrence can be minimized by improving households, the nutritional status of children, and by increasing awareness regarding its prevention and management.</p> Pramila Poudel, Harikala Soti Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Quality of life and its associated factors among the elderly population living in their own homes <p><strong>Introduction:</strong> Quality of life among elderly individuals is an important area of concern that reflects the health status and well-being of this vulnerable population. Quality of life among elderly individuals is a neglected issue, especially in developing countries such as Nepal. The objective of this study was to assess the quality of life and its associated factors among the elderly population living in their own homes.</p> <p><strong>Methods:</strong> A community-based cross-sectional study was conducted among 234 elderly individuals living in the Syangja district of Nepal. Quality of life was assessed by the World Health Organization Quality of Life BREF (WHOQOL-BREF) tool. Sociodemographic data were recorded by using a structured questionnaire. Independent t-tests and multiple linear regression were performed.</p> <p><strong>Results:</strong> Among 234 respondents, 54.7% of the elderly were 60 to 69 years old and 57.7% were female. The overall mean standard deviation score of QoL was 57.80±11.89. A total of 56.4% of respondents had a fair quality of life. Multiple linear regression analysis showed that physical exercise was associated with physical, psychological and social dimensions of quality of life. Education status was associated with physical dimension, chronic disease was associated with psychological dimension and past occupation was associated with environmental dimension. Age (p-value 0.032), marital status (p-value 0.047) and physical exercise were associated with overall fair quality of life.</p> <p><strong>Conclusions:</strong> More than half of the elderly have a fair quality of life and nearly half have a poor quality of life. Age, marital status, educational status, and physical exercise are factors influencing their quality of life. Local activities and awareness should be encouraged to enhance the Quality of life of elderly people.</p> Sharmila Paudel, Surendra Dhungana, Sharad Koirala, Sanju Banstola Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Prevalence of type 2 diabetes and its associated factors among general population of Pokhara Metropolitan City <p><strong>Introduction:</strong> Diabetes mellitus is emerging as a major public health problem in Nepal. This study aimed to assess the prevalence of type 2 diabetes and its associated factors among the general population of Pokhara Metropolitan City.</p> <p><strong>Methods:</strong> A community-based cross-sectional study was conducted from August 2018 to October 2019, involving a total of 617 participants aged 30 to 90 years in Pokhara Metropolitan. Participants were selected using a systematic random sampling technique. Data were collected using face-to-face interviews from consented participants. Data analysis was done using SPSS 20.0. Descriptive statistics, chi-square tests, and binary logistic regression were utilized. The level of significance was set at a p-value &lt; 0.05.</p> <p><strong>Results:</strong> The overall prevalence of type 2 diabetes was 112(18.2%), with 58(19.4%) among males and 54(17%) among females. Out of the participants with diabetes, 54(48.2%) were newly identified by the study. Older age, illiteracy, physical inactivity, family history of diabetes, known cases of hypertension, alcohol consumption, and obesity were found to be significantly associated with type 2 diabetes.</p> <p><strong>Conclusions:</strong> The study revealed a relatively higher prevalence of type 2 diabetes. Interventions on promoting physical activity, controlling alcohol consumption, maintaining body weight, and controlling hypertension may help in the prevention of diabetes<br />among the study population. It shows there is an urgent need for community awareness programs focusing on the disease and its risk factors.</p> Neelam Shrestha, Gemorina Vaidya Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Anxiety and depression among senior citizens of Pokhara Metropolitan, Kaski, Nepal: A cross-sectional study <p><strong>Introduction:</strong> A decrease in physical and cognitive functioning, and poor social relationship makes older people more vulnerable to anxiety and depression. The objective of this study was to assess anxiety and depression among senior citizens of Pokhara metropolitan city, Kaski, Nepal.</p> <p><strong>Methods:</strong> A cross-sectional comparative research design was adopted to assess anxiety and depression among senior citizens residing in an old age home and at their own home. An old age home in Pokhara was randomly selected and samples were selected using census method from that center. Then, an equal number of participants were selected from a randomly selected ward of Pokhara i.e. ward no 17 who were living in their own homes using a convenience sampling technique. Structured standard tools like Anxiety Scale-10 (ADS-10) and Geriatric Depression Scale- short version (GDS-15) were used for data collection and the data were collected using the interview technique. Descriptive statistics (mean, frequency, percentage, and standard deviation) and inferential statistics (chi-square test and independent t-test) were used.</p> <p><strong> Results:</strong> Among 80 respondents, 30.00% had severe anxiety symptoms, 16.25% had moderate anxiety symptoms, 62.50% of respondents had suggestive depression symptoms and 10.00% had no depression. Anxiety level was significantly associated with their status of living (p=0.045) and having comorbidity (p=0.027). Depression level was significantly associated with work status (p=0.036) and having co-morbidity (p=0.013).</p> <p><strong>Conclusions:</strong> Nearly half of the respondents had anxiety symptoms whereas one-third had depression symptoms. Senior citizens living in old age homes reported more symptoms of anxiety and depression than those who were living in their own homes. It is necessary to address the psychological aspects of the elderly and manage them holistically.</p> Sunita Gurung, Bindu Thapa, Muna Silwal Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Evaluation of clinical spectrum of Hepatitis A in children admitted at a tertiary care center in Western Nepal <p><strong>Introduction:</strong> Hepatitis A is one of the causes of morbidity and mortality in children in developing countries like Nepal. Hepatitis A virus is a positive-strand RNA virus that is transmitted feco-orally through person-to-person contact. Lack of awareness, overcrowding, and poor sanitation have led to increased infection mainly in many rural areas. This study was conducted to assess the clinical course of hepatitis A, blood parameters and its associated complications in patients admitted pediatric ward.</p> <p><strong>Methods:</strong> A hospital-based cross-sectional study was conducted on pediatric patients who had presented with icterus. Only serologically confirmed cases by the detection of IgM antibodies against Hepatitis A virus (HAV), ELISA were included in the study group. The clinical course and lab profiles of the patients were analyzed.</p> <p><strong>Results:</strong> A total of 75 patients were positive for HAV IgM A (serology) and were included in the study. The majority of children seen were in the age group of 5 to 12 years (51%). The most common symptoms were icterus. More than a fivefold rise in AST and ALT (SGPT) was seen in 58 cases (77.3%) and 62 cases (82.6%) respectively. More than 2,000 U/L of AST and ALT were seen in 10 cases (13.3%) and 14 cases (18.6%) respectively.</p> <p><strong> Conclusions:</strong> It was found that vomiting, abdominal pain and icterus were most common clinical features. Elevated prothrombin time and raised liver enzymes were most common lab findings. The most common abdominal ultrasound finding was ascites. No patients presented with severe complications.</p> Nabaraj Subedi, Bandana Shrestha, Arjun Bhattarai, Shankar Paudel, Namrata KC Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Assessment of canthal index among the Nepalese and Indian MBBS students of a Medical College in Eastern Nepal <p><strong>Introduction:</strong> The human face is a symbol of artistic expression and identity, with the orbit being a crucial factor in evaluating facial attractiveness. Various orbital measures, such as interpupillary distance, nasal limbus to temporal limbus, inner intercanthal distance, and outer intercanthal distance, are significant in ophthalmology and can help diagnose naso-orbitoethmoid damage, hypertelorism, and traumatic telecanthism. Hence, this study aimed to determine inner and outer canthal distances, mean canthal index values, and compare these values in the Indian and Nepalese MBBS students of Nobel Medical College Teaching Hospital.</p> <p><strong>Methods:</strong> A comparative cross-sectional study was conducted among 64 Indian and 128 Nepalese MBBS students aged 18 to 25 years in the Department of Anatomy at Nobel Medical College Teaching Hospital, Biratnagar from April to September 2023. The study used a convenience sample technique and involved measuring the inner canthal distance, outer canthal distance and calculating the canthal index.</p> <p><strong>Results:</strong>The overall mean canthal index was 17.93±3.13, the mean outer canthal distance and inner canthal distance were found to be 110.66±12.34 mm and 19.85±4.24 mm respectively. The mean value of the canthal index for Indian and Nepalese students was found to be 18.09±2.99 and 17.85±3.21 respectively.</p> <p><strong>Conclusions:</strong> The study found no significant differences in canthal distance or index between Nepalese and Indian students, possibly due to race and geographical habitat pattern similarities.</p> Diwakar Kumar Shah, Shalini Bhakta, Sanzida Khatun, Samyog Mahat, Manisha Jha, Nitasha Sharma Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Prevalence of anxiety among pre-clinical medical students: A cross-sectional study <p><strong>Introduction:</strong> A major worldwide health problem, anxiety disorders have detrimental morbidity and death rates. The<br />study aimed to assess the status of generalized anxiety disorder and its association with related explanatory variables<br />among medical college.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted among MBBS students of Gandaki Medical College studying in 1st and 2nd years using a self-administered questionnaire. The study was conducted from February 14 to 28, 2024. The study used a scale to measure anxiety levels using a 4-point Likert-scale Generalized Anxiety Disorder (GAD) with scores ranging from minimal 0 to maximum 21 Chi-square tests were applied at a 5% level of significance to find out the association of anxiety categories with respondents’ characteristics.</p> <p><strong>Results:</strong> Out of 100 total respondents, 51% of the respondents were male, 41% were at age of 20 or below, and 94% were from the Hindu religion. Of total, over 25% of respondents reported daily nervousness, anxiety, and worry, while 31% experienced excessive worry and 25% experienced easily annoyed or irritable symptoms. The study found that 67% had generalized anxiety disorder including 27% had mild anxiety, 17% had moderate anxiety, and 23% had severe anxiety. Out of the total 21 scores, the GAD score in the study was found to have a mean score of 8.86. In addition, the study found a significant association of respondents’ sex and screen time with anxiety, but no significant association was found with age, academic year, caste, family type, or sleep hour.</p> <p><strong>Conclusions:</strong> This study highlights a relatively higher level of generalized anxiety disorder among medical students, emphasizing the need for early detection, preventative measures, and treatment programs to improve their quality of life.</p> Sanju Banstola, Sabina Lamichhane Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Assessment of pattern of mandibular third molar impaction and its associated clinical symptoms in patients visiting tertiary center in Gandaki Province <p><strong>Introduction:</strong> Mandibular third molars show the highest rate of impaction. Eruption status, position, and angulation<br />are associated with different symptoms. Thus, this study was conducted to assess the mandibular third molar impaction<br />pattern and associated symptoms.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted on 426 patients visiting a tertiary center in Gandaki Province. Data collection was done from September 2023 to April 2024. Intraoral examination and orthopantamogram were assessed. The impaction depth and ramus relation of lower third molars were recorded according to the Pell and Gregory classification. The angulation was documented based on Winter’s classification. The associated symptoms including pain, caries, pericoronitis, swelling, trismus, pus discharge, food lodgement, and halitosis were also noted. The frequency of level, angle, and depth of impaction were calculated. The chi-square test was used to assess the association of angulation of impaction with sex.</p> <p><strong>Results:</strong> The mean age of the subject was 33.77±8.86 (range 19 to 68). The most common angulation of impaction was vertical (35.68%) with Level A (46.47%) depth of impaction and Class I (46.47%) ramus relation. Pain (57.98%), distal caries in the second molar (15.49%), and pericoronitis (14.55%) were found to be the most commonly associated symptoms.</p> <p><strong>Conclusions:</strong> Class I vertical level A impaction was most common impaction in this study. Pain followed by caries in distal aspect of second molar and pericoronitis were the common chief complaint presented by the patients with impacted mandibular molars.</p> Dhruba Chandra Poudel, Sushil Subedi, Ujjwal Koirala, Namrata Gyawali Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Feasibility of Arantius duct maneuver for tunneling between middle and left hepatic veins and their isolation for liver resection: A cadaveric study <p><strong>Introduction:</strong> Arantius duct is the remnant of ductus venosus arantii which, during the fetal development connects umbilical portion of portal vein to the inferior-venacava. It runs from the left branch of portal vein and its fibers insert into either the left hepatic vein or pass between left and middle hepatic vein. Arantius duct when retracted, helps in isolation of left hepatic vein from middle hepatic vein, this maneuver is Arantius duct maneuver.</p> <p><strong> Methods:</strong> This cross-sectional observational study was carried out at College of Medical Sciences Teaching Hospital, Nepal. The study included 25 cadaveric livers. Meticulous dissection was done on the livers, data were collected in proforma and entered into IBM SPSS 16.0 and electronically analyzed.</p> <p><strong>Results:</strong> The mean length of the Arantius duct was 54.76±3.74 mm (48mm to 63mm). The mean thickness of the duct was 5.64±0.56 mm (4.8mm-7mm). The duct terminated at the common trunk of MHV and LHV in 16(64%) cases and terminated at LHV in nine (36%) of specimens. In the presence of common trunk, the Arantius duct maneuver for tunneling between the left and middle hepatic vein was successful in 14(87.5%) of the specimens in this study. The maneuver was 100% successful in isolating left hepatic vein when it had a separate origin.</p> <p><strong>Conclusions</strong>: Arantius duct maneuver is a safe approach to tunnel between the middle and the left hepatic veins and their isolation for liver resection. It allows better vascular control with less post-operative morbidity associated to increased blood loss and reduces the risks of hepatic congestion post-surgery due to possible vascular compromise.</p> Sagar Khatiwada, Prasun Yadav, Narayan Prasad Belbase, Binaya Timilsina, Saroj Pradhan, Sushim Bhujel Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Comparison of tooth size and arch width of crowded and uncrowded Class I occlusion in individuals visiting a tertiary care center in Nepal <p><strong>Introduction:</strong> The knowledge of tooth width and arch size is essential for esthetic and orthodontic rehabilitation. Hence, this study was done to assess the extent to which the arch width and mesiodistal tooth size were responsible for the crowding in individuals visiting a tertiary care center in Nepal.</p> <p><strong>Methods:</strong> This was a cross-sectional study conducted on dental casts which was divided into two groups. The first group consisted 30 casts of normal occlusions (15 males and 15 females) without crowding. The second group consisted same number of casts exhibiting class I malocclusion with crowding. Mesiodistal teeth dimensions and arch width were measured. The data was analyzed using an independent sample t-test with a level of significance set at p&lt;0.05.</p> <p><strong>Results:</strong> Statistically significant difference in mesiodistal width of the upper central incisor ( 1st group 8.5±0.33, 2nd group 9.26±0.47; p-value=0.027) and canine (1st group 7.52±1.03, 2nd group 8.14±0.34; p-value=0.012), lower canine (1st group 6.38±0.84, 2nd group 7.12±0.38; p-value=0.005), 1st (1st group 6.63±0.81, 2nd group 7.23±0.46; p-value =0.023) and 2nd (1st group 6.66±0.85, 2nd group 6.97±0.52; p-value=0.035) premolar was observed. Buccal intercanine width of the maxillary and mandibular arch (1st group 38.25± 3.14, 2nd group 36.45 ± 1.44; p-value=0.003 and 1st group 30.88±1.6, 2nd group 25.48± 0.75; p-value=0.05 respectively), maxillary buccal intermolar width (1st group 58.44±5.0, 2nd group 55.75± 1.7; p-value=0.001), mandibular buccal (1st group 56.75± 4.2, 2nd group 55.30±2.12; p-value=0.013) and lingual intermolar width (1st group 32.50±3.4 , 2nd group 28.73±1.88; p-value=0.036) were found to be larger in the first group.</p> <p><strong>Conclusions:</strong> The results of this study suggest that both the tooth size and arch width has a role in developing crowding.</p> Manju Pandey, Umesh Parajuli, Anita Dahal, Bijayata Shrestha Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Complications of porcelain fused to metal crowns after five years of cementation at a tertiary care center in Kaski <p><strong>Introduction:</strong> Porcelain fused to metal (PFM) crowns are given to restore badly broken down teeth, to reinforce root canal treated teeth. The common complications are chipped-off porcelain, open contact, dental caries of an abutment, dental caries of adjacent teeth, fracture of an abutment, dislodged crowns, and periodontal problems.</p> <p><strong>Methods:</strong> This was a hospital-based cross-sectional study conducted at the outpatient department of Prosthodontics, College of Dental Surgery, Gandaki Medical College. The patients of age group 25 to 50 years who had undergone PFM crowns minimum of five years back in the Department of Prosthodontics were examined for complications of chipped-off porcelain, open contact, periodontal pocket, dislodged crowns, fracture of abutment tooth, caries in abutment and caries in adjacent teeth.</p> <p><strong>Results:</strong> The average age was 40.85 ± 8.74 years. The average duration post-cementation of porcelain fused to metal crowns was 6.15±1.52 years. The complications were open contacts 23(28.8%), chipped off porcelain crowns 10(12.5%), periodontitis 4(5.0%), dislodged crown 7(8.8%), fractured abutment 2(2.5%), dental caries in abutment teeth 2(2.5%) and dental caries in adjacent teeth 3(3.8%).</p> <p><strong> Conclusions:</strong> The most common complication in porcelain fused to metal crowns post five years of cementation was open contact followed by chipped-off crowns and periodontitis.</p> Sapna Laxmi Tuladhar, Pratik Manandhar, Neeta Thapa, Dilesh Pradhan, Umesh Parajuli Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Estimation of cervical vertebral bone age by using mathematical formula: A cephalometric study <p><strong>Introduction:</strong> Craniofacial growth is an integral part of orthodontic diagnosis and treatment. Optimal effectiveness of orthodontic/orthopedic appliance is achieved during pubertal growth spurts, evaluation of maturation and growth potential is important. Radiographic assessment of hand-wrist bones is a reliable indicator of skeletal maturation, however, it requires a separate radiograph. The objective of this study was to evaluate skeletal maturation using cervical vertebral dimensions.</p> <p><strong>Methods:</strong> This is an analytical cross-sectional study using lateral cephalograms of 52 subjects (26 males and 26 females). Manual tracing was done on the collected sample. Landmarks on C3 and C4 were marked. Measurement was recorded and cervical vertebral bone age was calculated by using the formula. Mandibular growth potential was calculated from cervical vertebral bone age. Paired-t test was performed to compare the cervical vertebral bone age and the chronological ages among the samples and between sexes. The correlation between the cervical vertebral bone age and the mandibular growth potential was determined by use of Pearson’s correlation coefficient.</p> <p><strong>Results:</strong> The mean chronological and cervical vertebral bone age was 13.38±1.42 and 14.08±1.83 years respectively and was significant. No significant differences was found among male samples (p=0.230) whereas it was significant among females (p=0.002). A strong negative correlation was found between the cervical vertebral bone age and mandibular growth potential (r= -0.943). Linear regression equation was derived as CVBA= -4.2857+1.4286CA.</p> <p><strong>Conclusions:</strong> The study showed a strong negative correlation between cervical vertebral bone age and mandibular growth potential</p> Rashmi Bhattarai, Rabindra Man Shrestha, Jyoti Dhakal Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 The road less travelled <p>NA</p> P Ravi Shankar Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Cost-effectiveness of antihypertensives: A major factor for clinical decision making <div> <p class="Normal1"><span lang="EN-GB">The cost study of antihypertensive therapy is essential because hypertension is one of the major chronic illnesses causing economic burden to the patients. The expense associated with chronic illnesses like hypertension raises concerns because patients often need long-term medication, often requiring multiple drugs simultaneously. The cost-effectiveness analyses of antihypertensive medications are necessary to determine the most economical treatment options. Since protocols and circumstances vary across settings, such analyses must be conducted to ensure applicability in diverse scenarios.</span></p> </div> Sabita Paudel, Sudeshana Adhikari Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Active learning for competent medical graduates: Need of the hour <p>No abstract</p> Nuwadatta Subedi, Krishna Subedi, Rebicca Ranjit Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Adnexal torsion in a 20-year-old nulliparous woman <p>Twisting of an organ or a part of it along its own axis is known as torsion. Twisting of the ovary, often along with the fallopian tube is known as adnexal torsion. Both the ovaries and fallopian tubes are often involved so the preferred term is adnexal torsion rather than ovarian torsion. It is the fifth most common gynaecological emergency. Twisting of the ovary, often along with the fallopian tube on its ligamentous supports results in vascular compromise and infarction of the ovary. The patient usually presents with a sudden onset of intense pain; however, this is not always the case. Imaging plays a vital role in the diagnosis of adnexal torsion and the definitive management of surgical detorsion which facilitates preservation of the ovary.</p> Kismat Gurung, Pritha Adhikari Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000 Polyneuritis cranialis: A rare variant of Guillain Barré syndrome <p>Polyneuritis cranialis is a rare variant of Guillain-Barré Syndrome. We hereby report a thirty-year-old male with symptoms of headache, vomiting, and blurred vision. Polyneuritis Cranialis was confirmed after considering clinical findings, examinations, and laboratory tests while ruling out other differentials. Intravenous Immunoglobulin treatment over five days led to gradual improvement and discharge on the twentieth day post-admission.</p> Elina Maharjan, Namrata Pandey, Sunil Maharjan, Niranjan Acharya, Rochak Kansakar Copyright (c) 2024 The Author(s) Thu, 20 Jun 2024 00:00:00 +0000