Journal of Gandaki Medical College-Nepal <p>An official publication of the Gandaki Medical College Teaching Hospital &amp; Research Centre Pvt. Ltd.</p> en-US <p>The statements or opinions or ideas expressed in the Journal are the personal views of authors and do not represent the official views of J-GMC-N editorial board.</p> (Dr. Nuwadatta Subedi) (Sioux Cumming) Wed, 05 Jan 2022 00:00:00 +0000 OJS 60 Role of telemedicine and its implementation in Nepal <p>No abstract</p> Krishna Subedi, Nuwadatta Subedi Copyright (c) 2021 Krishna Subedi, Nuwadatta Subedi Fri, 31 Dec 2021 00:00:00 +0000 Vectorial analysis of the electrocardiogram from conventional limb leads in healthy adult Nepalese females <p><strong>Introduction: </strong>ECG interpretation plays a vital role in the initial evaluation of patients presenting with cardiac complaints. Assessment of degree of cardiac vector is one of the important parameters to be studied in ECG.</p> <p><strong>Methods: </strong>A prospective cross-sectional study was carried out among 84 female subjects, aged 18- 40 years of age, including students and staff of Gandaki Medical College Teaching hospital and Research Center, Pokhara, Nepal over a period of one month from 1<sup>st</sup> Oct to 1<sup>st</sup> Nov 2021. A Standard ECG machine was used and the ECG was recorded using the conventional limb leads. The individual mean electrical axis of the heart was plotted using the net voltage of QRS complex of Lead-I and Lead-III. The possible correlation between cardiac vector and physical measurements like height weight BSA and BMI were analyzed. The data were analyzed in SPSS version 27.</p> <p><strong>Results:</strong> The normal mean electrical axis of the healthy female subjects was observed as 61.7±23.51°. There was a significant positive correlation of cardiac vector with height (p&lt; 0.05), whereas a negative correlation was observed with weight and BMI (p&lt; 0.01). However, there was no significant correlation with BSA. In our study, we observed the maximum left axis cardiac vector as -2° and right axis as 98° among 84 female subjects.</p> <p><strong>Conclusion: </strong>Documentation of cardiac vector was made using standard bipolar limb leads in normal healthy female subjects. BMI is involved in the deviation of cardiac vector with a negative correlation. This observation could make it quite attractive for use in clinical practice.</p> Rajesh Prajapati, Neebha Amatya, Rajab Rana Magar, Ripti Shrestha Copyright (c) 2021 Rajesh Prajapati, Neebha Amatya, Rajab Rana Magar, Ripti Shrestha Fri, 31 Dec 2021 00:00:00 +0000 A study of height, weight and body mass index in Nepalese <p><strong>Introduction: </strong>The height measurement is an important anthropometric measurement which can be directly correlated with health status of an individual. Body weight of an individual refers to total body mass and is also important indicator of health status of people. Body mass index (BMI) is a key index for relating weight to height. It is defined as the body mass divided by the square of the body height, The BMI is an attempt to quantify the amount of body tissue mass in an individual, and then categorize that the person as underweight, normal weight, overweight or obese.</p> <p><strong>Objectives: </strong>To find out the average height and weight, to calculate BMI and find out its average value and to correlate height and weight in Nepalese population.</p> <p><strong>Methodology: </strong>A cross sectional study was conducted in subjects from different parts of Nepal. Three hundred twenty one healthy subjects of 25-40 years of age group were studied. Height and weight of subjects were recorded and BMI was calculated. Data were analyzed using SPSS.</p> <p><strong>Result: </strong>In overall Nepalese population, Mean height was found to be 156.6 ± 6.3 cm; mean weight 56.6 ± 11.4 kg and BMI 20.9 ± 1.8 kg/m<sup>2</sup>. Pearson’s correlation co-efficient(r) for height and weight was 0.88.</p> <p><strong>Conclusion: </strong>There was partial positive correlation between height and weight. There was statistically significant difference in height, weight and BMI between Nepalese male and female(p&lt;0.05).</p> Prakash Baral, Rami Shrestha, Ratindra Nath Shrestha, Dinesh Banstola, Rajesh Prajapati Copyright (c) 2021 Prakash Baral, Rami Shrestha, Ratindra Nath Shrestha, Dinesh Banstola, Rajesh Prajapati Fri, 31 Dec 2021 00:00:00 +0000 Prevalence of partial edentulism among the patients visiting a Tertiary Health Care Center in the Western Region, Nepal <p><strong>Introduction: </strong>Tooth loss causes impairment, functional limitation, physical, psychological, and social disability. <em>&nbsp;</em>Hence, the study of pattern of tooth loss can provide a rough information about the frequency, cause and magnitude of oral problems, its sequelae that eventually can act as mirror image of prosthodontic treatment needs.&nbsp;</p> <p><strong>Objectives: </strong>To assess the prevalence of partial edentulism and its etiology, to determine its association with sociodemographic parameters, and to find out the motivational factor/s for replacement in willing patients.</p> <p><strong>Methods:</strong> Total 417 patients with partial edentulism were examined intraorally on the basis of Kennedy’s classification with Applegate’s modification. The descriptive analysis was done using frequency distribution. Pearson Chi-square analysis test was used to determine the association between demographic variables and type of tooth loss where p-value ≤0.05 was considered statistically significant.</p> <p><strong>Results:</strong> Partial edentulism was more prevalent in mandibular arch (41.7%) followed by both arches (30.9%). Kennedy’s Class III was the commonest and Kennedy’s class III modification 1 was second most common type of partial edentulism. Age and educational status had statistically significant association while gender had no association with various classes of partial edentulism. Dental caries (62.8%) followed by periodontitis (25.9%) were the major causes of tooth loss. Functional demand (46.8%) was the key motivational factor for the replacement among those who were willing (78.4%).</p> <p><strong>Conclusions: </strong>This study can help in assessing the epidemiological features of partial edentulism of one community in a more classified form and can help gather information necessary to assess the treatment needs.</p> <p><strong>&nbsp;</strong></p> Pratik Manandhar, Rebicca Ranjit, Sapna Laxmi Tuladhar, Arjun Bhandari Copyright (c) 2021 Pratik Manandhar, Rebicca Ranjit, Sapna Laxmi Tuladhar, Arjun Bhandari Fri, 31 Dec 2021 00:00:00 +0000 Histopathology of Polyps and Cancer of Colorectum: A ten years study from a tertiary care center <p><strong>Introduction and objectives:</strong> Polyps and colorectal cancer have overlapping clinical presentation and may be difficult to diagnose on clinical grounds alone and close clinicopathological correlation is required for correct diagnosis and management. This study was aimed to see the spectrum of polyps and cancer in colorectum, see the percentage of colorectal cancer in younger individuals, see association between histologic grade and pathologic stage at presentation and compare site of tumor and pathologic stage at presentation in younger and older age group.</p> <p><strong>Methods:</strong> This study was carried out on 138 consecutive cases of polyps and malignant lesions of colorectum during a time period of 10 years from January 2011 to December 2020.</p> <p><strong>Results:</strong> Age of the patients ranged from 2 – 90 years with mean 45.1 years and a male female ratio 2:1. There were 58 (42.0%) cases of polyps and 80 (58.0%) cases of malignancies. 37 (46.3%) malignancy cases were seen in individuals ≤ 50 years of age. Most common site of involvement was rectum in 80 (58.0%) cases. Most common non-neoplastic polyp was retention polyp comprising 25 (67.6%) and most common neoplastic polyp was adenoma comprising of 18 (85.7%) cases. Most common malignancy was adenocarcinoma comprising 75 (93.8%) cases.</p> <p><strong>Conclusion:</strong> Significant number of malignancies is seen in younger individuals stressing the need for suspicion and surveillance in this age group. Histologic grade is an important prognostic parameter and there is no difference in site of tumor and stage at presentation between younger and older age group.</p> Binita Goyal Copyright (c) 2021 Binita Goyal Fri, 31 Dec 2021 00:00:00 +0000 A study on referral of patients in Department of Psychiatry at Lumbini Medical College and Teaching Hospital <p><strong>Introduction</strong>: In a developing country like Nepal, where there is inadequate awareness but more social stigma towards psychiatric illnesses among people, there is an important role of referral psychiatry. Referral psychiatry has been considered to be an interface between psychiatric and non-psychiatric medicines as practiced in general hospital settings. This study analyses the psychiatric problems among patient referred to psychiatry department from other outpatient departments and emergency department in a tertiary care centre.</p> <p><strong>Methods: </strong>This was a descriptive hospital-based study conducted among patients who were referred to psychiatry department from different outpatient departments of Lumbini Medical College and Teaching Hospital from November 1, 2019 to April 30, 2020. Ethical issues were considered strictly. Data were entered into Statistical Package for the Social Sciences version 21.0 and descriptive analysis was done.</p> <p><strong>Results: </strong>A total of 781 patients were referred out of which more than half (n=487, 62.35%) were females and the most common age group was 41 to 50 years (n=175, 22.4%). Majority of patients (n=284, 36.4%) were referred from medicine department. The most common psychiatric illness diagnosed were those included under International Classification of Diseases 10th Revision F40-48 (Anxiety, Dissociative, Stress-related, Somatoform and other Non-Psychotic Mental Disorders).</p> <p><strong>Conclusions: </strong>Referral psychiatry plays an important role to diagnose the undiagnosed psychiatric illnesses earlier and better and manage accordingly so it should be prioritized and practiced in health centers.</p> Ram Prasad Lamichhane, Bhaskar Sharma, Prakash Neupane, Nisha Bhattarai, Sandipa Sharma Copyright (c) 2021 Ram Prasad Lamichhane, Bhaskar Sharma, Prakash Neupane, Nisha Bhattarai, Sandipa Sharma Fri, 31 Dec 2021 00:00:00 +0000 Knowledge, Attitude and Practice among endodontists of Nepal in patient management during COVID-19 arena <p><strong>Background:</strong> Coronavirus disease, 2019 (COVID-19) is an infectious disease caused by the severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2).COVID-19 is a global pandemic affecting all aspects of life in all countries. Endodontist are at inherent risk because of aerosol generating procedures. The objective of the study was to assess the knowledge, attitude and practice (KAP) among Endodontists of Nepal to combat the COVID 19 pandemic.</p> <p><strong>Method:</strong>A web-based cross-sectional study was conducted among Endodontist of Nepal from March to June 2021.Convenient sampling method was adopted. The data were analysed using SPSS version 20.Descriptive statistics was performed, percentage and frequency distribution were assessed. Chi-square tests wereused to see the association between the categorical variables. A p-value of &lt;0.05 was considered statistically significant.</p> <p><strong>Results: </strong>&nbsp;Out of the total 81 Endodontists who responded to our study, 55.6% of them were females and 44.4% males. Around 65%were from Bagmati province.Majority (87.7%) of responders reported that they categorize the cases on the basis risk assessment, 56.8% do not perform routine procedures during the pandemic. Maximum (97.5%) of the responders discuss about COVID-19 with the patients.About 55% of the responders use rubber dam during the endodontic procedures, while 17.3% of the responders do not use them at all.</p> <p><strong>Conclusion:</strong>Endodontists of Nepal werefound to have good knowledge, attitude and practice score, which is important to overcome the present pandemic scenario of COVID19.Certain pitfalls in attitude and practice level can be decreased by efficient training programs, precise guidelines, and treatment protocols.</p> Deepa Kunwar, Snigdha Subham, Manisha Nepal, Jwolan Khadka Copyright (c) 2021 Deepa Kunwar, Snigdha Subham, Manisha Nepal, Jwolan Khadka Fri, 31 Dec 2021 00:00:00 +0000 Role of Nasal parameters in gender determination among medical students <p><strong>Introduction: </strong>Anthropometric measurement of the nose has a great importance to differentiate gender, race, and ethnicity. Nasal index is an important parameter in forensic sciences and rhinoplasty surgery. Our aim is to compare the nasal index of both males and females and its role to identify gender differences among medical students.</p> <p><strong>Methods: </strong>First and second year medical students were chosen and height, breadth and nasal index were calculated. The height and width of the nose was measured using a vernier caliper. The nasal index of both males and females were calculated and compared and based on this, the nasal shape was also determined.</p> <p><strong>Results</strong>: Among 184 total participants, 114 (61.9%) were Nepalese and 70 (38.1%) were Indian. In the Nepalese cohort, mean nasal height for male students was 4.58 ± 0.37 cm which was higher than females (4.39 ± 0.34 cm). The mean nasal index was higher among males in students of both the countries. The mesorrhine was most common type of morphology found among all students.</p> <p><strong>Conclusions</strong>: Nasal index of male medical students was significantly higher than females. Mesorrhine nose was the commonest type of nose in our study. This information may be used to estimate gender differences. </p> Bhima Neupane, Kanaklata Iyer, Brihaspati Sigdel Copyright (c) 2021 Bhima Neupane, Kanaklata Iyer, Brihaspati Sigdel Fri, 31 Dec 2021 00:00:00 +0000 Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture <p><strong>Introduction:</strong> Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture.</p> <p><strong>Methods:</strong> This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively.</p> <p><strong>Results:</strong> Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up.</p> <p><strong>Conclusions:</strong> The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.</p> Rabi Mohan Dhakal, Rabindra Prasad Shrestha, Bhola Shrestha, Ishwor Sharma Kandel, Karuna Acharya, Krishna Bahadhur Bista, Pravakar Parajuli Copyright (c) 2021 Rabi Mohan Dhakal, Rabindra Prasad Shrestha, Bhola Shrestha, Ishwor Sharma Kandel, Karuna Acharya, Krishna Bahadhur Bista, Pravakar Parajuli Fri, 31 Dec 2021 00:00:00 +0000 Food safety, sanitation and hygiene practices among street food vendors in Pokhara, Kaski <p><strong>Background</strong>: Street foods are unique and convenient urban food supply meanwhile it lacks the food hygiene and safety posing major public health risk. Thus, the study aims to identify the food safety, sanitation and hygiene practices of street food vendors.</p> <p><strong>Method:</strong> The study is cross sectional including 70 vending units selected conveniently. Structured interview schedule and observation checklist was used as data collection tool.</p> <p><strong>Result:</strong> The mean age of the respondent was 38.06 (±10.417) years with &gt;1/2 being females (61.4%). Majority (77.1%) had formal education, 37.1% earns&gt;40,000/month and 86 % had not taken any food hygiene training. Eighty percent of the respondents had fixed stall with about 83% sell freshly cooked food and 75% prepare it in market place. About 84% of the respondent revealed diarrhea as the most prevalent disease caused by poor hygiene. Very less (27%) have their health check-up regularly and about 68.6% prepare food when they are ill. Almost 50% heat food before serving, 58% wash dishes with tap water, 98.6% wash raw food before preparation and all of them wash cooking dishes daily. About half (48.6%) of the respondents re-use oil while cooking. Approximately in 77% refrigeration facility was available. The food vending was found to be good (&gt;50) in 54.3% and sanitation was good (&gt;50%) in 60%.</p> <p><strong>Conclusion</strong>: Overall sanitary conditions of the vending sites were good but instead needs improvement in most of the aspect of sanitary condition.</p> Nisha Bhandari, Babu Ram Bhusal Copyright (c) 2021 Nisha Bhandari, Babu Ram Bhusal Fri, 31 Dec 2021 00:00:00 +0000 Cernea's classification of the External Branch of the Superior Laryngeal Nerve during Microscopic Thyroidectomy at Gandaki Medical College, Pokhara <p><strong>Background: </strong>Preservation of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy is important because its injury may lead to frequent occurrence of vocal fatigue and the inability to perform phonation. The objective of the study was to identify and classify the nerve as per Cernea's classification using operating microscope during thyroidectomy</p> <p><strong>Method</strong>: Between January 2017 to December 2019, we evaluated 50 patients for the position of external branch of superior laryngeal nerve, who underwent microscopic thyroid surgeries in the department of ENT- head and neck surgery at Gandaki Medical College.</p> <p><strong>Results</strong>: In our study, we dissected a total 59 superior poles of thyroid from 50 patients and identified the nerve in all the cases. Of the total superior poles, 36 (61.01%) had type IIa EBSLN among which 24 was on the right side and 12 on the left followed by 19 (32.20%) patients with type IIb EBSLN among which 8 on right and 11 on left side. There were only 4 poles (6.77%) of type I with 3 on the right and 1 on the left side.</p> <p><strong>Conclusion</strong>: The EBSLN can be very efficaciously identified during a microscope assisted thyroidectomy. Cernea type 2a and 2b EBSLNs are in position to be at high risk of injury during ligation of the superior vascular pedicle, which can be avoided by prompt identification through a microscope and a meticulous extra capsular dissection technique.</p> Tulika Dubey, Brihaspati Sigdel, Rajendra Nepali, Neeraj KC Copyright (c) 2021 Tulika Dubey, Brihaspati Sigdel, Rajendra Nepali, Neeraj KC Fri, 31 Dec 2021 00:00:00 +0000 Price Variation of Injectable Antibiotics Commonly used in Bharatpur, Chitwan <p><strong>Introduction: </strong>High dispersion in price of injectable antibiotics makes choice of drugs difficult for the patients and increase economic burden. Thus, objective of this study is to find outrange of price variation of injectable antibiotics commonly used in Bharatpur, Chitwan.</p> <p><strong>Methods: </strong>Descriptive observational study of 30 commonly used injectable antibiotics available in medical stores of Bharatpur, Chitwan was done. Range in price variation of the study items of different pharmaceutical companies was calculated in terms of price percentage difference and price ratio by selecting the highest and lowest price. The effect of rise in number of companies for the same drugs over the prices was also studied subjectively based upon graph.</p> <p><strong>Results: </strong>We found that the price percentage difference was greatest (204.82%) for Ceftriaxone 500 mg. The maximum retail price (MRP) of the most expensive brand for Ceftriaxone 500 mg was almost three-fold higher than the MRP of the least expensive brand. The growing number of companies also increased dispersion in the price of drugs.</p> <p><strong>Conclusions: </strong>There is wide range of price variation of injectable antibiotic commonly used in the Bharatpur, Chitwan. Increasing number of companies in the market has further widened the range. Policy to regulate the price of injectable antibiotic is needed.</p> Ajit Kumar Sah, Anish Giri, Anjan Palikhey, Roshan Kumar Chaurasiya, Phoolgen Sah, Mukesh Mallik Copyright (c) 2021 Ajit Kumar Sah, Anish Giri, Anjan Palikhey, Roshan Kumar Chaurasiya, Phoolgen Sah, Mukesh Mallik Fri, 31 Dec 2021 00:00:00 +0000 A study of efficacy and feasibility of laparoscopic surgery in a tertiary care center, Pokhara, Nepal <p><strong>Introduction: </strong>Laparoscopic surgery is the gold standard technique for most of the gastrointestinal surgeries in developed countries. However, challenges in developing countries, apart from cost of instrumentation, include lack of awareness. Therefore, the aim of this study is to determine the efficacy and feasibility of laparoscopic surgeries in our part of the world.</p> <p><strong>Methods: </strong>Retrospective, cross-sectional study was carried out from January 1, 2018 to June 30, 2019. Patient’s information on demographic details, type of laparoscopic surgery, operation time, length of hospital stay, reasons for conversion to open surgery, and intra-operative and post-operative complication details were retrieved from the operation log book and patient’s chart.</p> <p><strong>Results: </strong>A total of 380 patients that underwent laparoscopic surgeries were included in the study. Out of 193 patients that underwent laparoscopic cholecystectomy, there were 144 (74.61%) females and 49 (25.38%) males with conversion rate of 4.66% and post-operative complication rate of 8.80%. Similarly, among 136 patients that underwent laparoscopic appendectomy, there were 68 (50%) females and 68 (50%) males with conversion rate of 4.41% and post-operative complication rate of 14.70%. Finally, amid 51 patients who underwent trans-abdominal pre-peritoneal approach, post-operative seroma collection was seen in three cases and port site hematoma formation was seen in two cases only.</p> <p><strong>Conclusions: </strong>Our results were comparable with various literature demonstrating that laparoscopic surgeries are safe and effective. However, evolution of laparoscopic surgery in developing countries is still slow. Therefore, effective training and availability of required instruments is needed. </p> Anuj Shrestha, Sunil Man Bijukchhe, Anand Bhattarai, Bhojraj Neupane, Ketki Kaushal Copyright (c) 2021 Anuj Shrestha, Sunil Man Bijukchhe, Anand Bhattarai, Bhojraj Neupane, Ketki Kaushal Fri, 31 Dec 2021 00:00:00 +0000 Psychological distress and its associated factors in health workers during COVID-19 pandemic in Nepal: An online survey <p><strong>Introduction: </strong>Psychological distress among healthcare workers amidst COVID-19 pandemic has emerged as a serious health problem. Understanding its magnitude is crucial to guide policies and interventions to improve their psychological wellbeing. This study assessed the psychological distress and its associated factors among health care workers in Nepal during the COVID-19 pandemic.</p> <p><strong>Methods: </strong>A cross-sectional online survey was carried out among 427 health workers currently working in Nepal from April 25 to June 10, 2020. Psychological distress was measured using “The Kessler Psychological Distress Scale” (K10). Descriptive statistics and inferential statistics were computed at a 5% level of significance. Ethical approval was taken from Nepal Health Research Council.</p> <p><strong>Results: </strong>A total of 427 healthcare workers participated in the study. Out of the total participants, 50.4% were males. Nearly half of the participants were medical doctors (48%) followed by nurses (22.2%), health assistants (12.2%) and 61% were non-government employees. The healthcare workers who experienced symptoms of psychological distress were 28.9%. Out of 123 respondents who had symptoms of psychological distress, 19% had mild, 7.3% had moderate and 2.6% had severe psychological distress. Female healthcare workers were more likely to have psychological distress than males [AOR: 1.75, CI: 1.05-2.92].</p> <p><strong>Conclusions: </strong>Psychological distress in healthcare workers during the COVID-19 pandemic is a matter of serious health concern. This issue demands urgent comprehensive intervention embracing the provision of a supportive environment and protective equipment, screening psychological outcomes and psychological counseling especially targeting female healthcare workers. </p> Nirmala Shrestha, Nisha Gurung, Sanju Banstola, Saurabh Kishor Sah, Sharad Koirala, Bimala Sharma Copyright (c) 2021 Nirmala Shrestha, Nisha Gurung, Sanju Banstola, Saurabh Kishor Sah, Sharad Koirala, Bimala Sharma Fri, 31 Dec 2021 00:00:00 +0000 Knowledge, attitude and practice of over-the-counter drug among undergraduate medical students-a cross sectional study <p><strong>Background:</strong> Self-medication of the over-the-counter (OTC) drug is practice all over the world. Although appropriate self-medication practice can address minor illness and is time and cost-effective, it can promote irrational use of medicine; prolong the illness, drug dependency and abuse. Medical students are the future medical practitioners and play the crucial role in counseling the patients. Therefore, the present study was conducted to assess the knowledge, attitude and practice of self- medication among undergraduate students.</p> <p><strong>Methods: </strong>An institution based descriptive, cross sectional study was conducted after ethical approval was taken from the Institutional ethical committee of Gandaki medical college teaching hospital and research center (GMCTHRC) and data was collected from May to July 2018. Descriptive and correlation analysis were done with the data. The results were expressed in percentages.</p> <p><strong>Results:</strong> Among 115 respondents, 60.9 % (70) were female and 39.1% (45) were male students. Majority of respondents (94.8%) believed that instruction on the label of the drugs should be followed and 78.3% respondents agreed that OTC drugs could interact with other prescribed drugs. However, only 53.9% respondents knew that OTC drugs were Group Ga drugs in Nepal. Despite good knowledge and attitude only 37.4% students had good practice in the rational use of the OTC drugs. Moreover, Antipyretic and analgesic drugs were the most commonly used drugs. However, only 36.84% respondents (p&lt;0.05) knew about the correct dose and duration to take the drugs.</p> <p><strong>Conclusions:</strong> We concluded that first year medical and dental should be motivated to use their knowledge into practice.</p> Bindu Malla, Deepti KC Copyright (c) 2021 Bindu Malla, Deepti KC Fri, 31 Dec 2021 00:00:00 +0000 Stump Appendicitis with Diagnostic Dilemma: A Case Report <p>Stump appendicitis is a rare delayed complication of incomplete appendectomy. The clinical symptoms and signs are like acute appendicitis. The possibility of stump appendicitis is not clear to all clinicians. It represents a diagnostic dilemma with incidence of one in 50,000 cases. We report how we encountered diagnostic dilemma during the management of a 30 years old male patient of acute abdomen with history of appendectomy done for acute appendicitis even years back.</p> Anil Kumar Sah, Rajeev Kumar Pandit, Muza Shrestha, Sundar Maharjan, Suman Prasad Sah Copyright (c) 2021 Anil Kumar Sah, Rajeev Kumar Pandit Wed, 05 Jan 2022 00:00:00 +0000