Journal of Kathmandu Medical College <p>The official journal of Kathmandu Medical College, Sinamangal, Kathmandu. Full text articles available. Content also available on the journal's own <a href="">website</a>.</p> <p>JKMC is a multidisciplinary, peer reviewed, open access, quarterly journal which publishes a wide range of scientific works including original research paper, case reports, reviews, editorials, book reviews and articles from medical students. It includes work from basic science, clinical science, dental, nursing and other related medical fields.</p> <p>Journal of Kathmandu Medical College does NOT charge authors for article submission and processing fees.</p> Kathmandu Medical College en-US Journal of Kathmandu Medical College 2091-1785 <p>Copyright © Journal of Kathmandu Medical College<br>The ideas and opinions expressed by authors or articles summarized, quoted, or published in full text in this journal represent only the opinions of the authors and do not necessarily reflect the official policy of Journal of Kathmandu Medical College or the institute with which the author(s) is/are affiliated, unless so specified.</p> <p>Authors convey all copyright ownership, including any and all rights incidental thereto, exclusively to JKMC, in the event that such work is published by JKMC. JKMC shall own the work, including 1) copyright; 2) the right to grant permission to republish the article in whole or in part, with or without fee; 3) the right to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4) the right to republish the work in a collection of articles in any other mechanical or electronic format.</p> Sonological grading of non-alcoholic fatty liver and comparison with liver enzymes <p><strong>Background</strong>: Non-alcoholic fatty liver disease (NAFLD) is becoming more well acknowledged as a significant contributor to liver-related morbidity and mortality.</p> <p><strong>Objectives:</strong> To assess the sonological grading of non-alcoholic fatty liver disease and comparison with liver enzymes.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted from 2022 August to 2023 January among the patients referred to radiology unit for liver sonography with diagnosis of non-alcoholic liver disease. Ethical approval was obtained from the institutional review committee of Kathmandu Medical College (Ref. 12082022/06). A convenience sampling method was used. The sample size calculated was 107. Descriptive statistics (frequencies, means, and standard deviations) was used to describe the variables of interest. One-way analysis of variance was applied for comparison of serum liver enzymes in between various grades of NAFLD at 5% significance level.</p> <p><strong>Results:</strong> Mean age of the patients was 37.9 ± 17.8 years, with 60% females. Most patients had grade I NAFLD (82, 76.6%), whereas 23 (21.5%) were of grade II. Levels of liver enzyme: Serum glutamic pyruvic transaminase (SGPT) with p-value 0.02 and serum glutamic oxaloacetic transaminase (SGOT) with p-value 0.03 were associated with fatty liver grade.</p> <p><strong>Conclusion:</strong> Ultrasound-based grading of the severity of NAFLD was associated with abnormalities in the liver enzyme profile of patients. The SGPT and SGOT levels correlated with increasing severity of NAFLD based on ultrasound. </p> Arbind Chaudhary Pankaj Kafle Lalit Karki Narayan Bikram Thapa Copyright (c) 2023 2023-06-30 2023-06-30 12 2 71 74 10.3126/jkmc.v12i2.53553 Assessment of inconclusive biopsies at a tertiary care dental hospital <p><strong>Background:</strong> Biopsy has crucial role in definitive diagnosis of lesions followed by appropriate treatment of the same. There are situations to clinicians when the report from the oral pathologists comes as “inconclusive biopsy”, instead of a definitive diagnosis.</p> <p><strong>Objectives:</strong> To determine the frequency and reasons for inconclusive biopsy as the final diagnosis, in biopsy samples obtained for histopathological evaluation.</p> <p><strong>Methods:</strong> This retrospective chart review was conducted in a total of 982 biopsy reports from the archive of the Department of Oral Pathology of Kantipur Dental College. Reports from 2016 to 2021 A.D were assessed after institutional ethical approval utilising convenience sampling. Clinical details were assessed from the patient's biopsy requisition form. Inconclusive diagnosis as the final sign-outs were evaluated, to analyse the reasons for such reports according to the standard criteria. For analysis, SPSS v.20 software was used.</p> <p><strong>Results:</strong> Out of 982 biopsy reports, 140 (14.2%) inconclusive biopsy reports were recovered. The reasons for inconclusive biopsy in descending order was 129 (92.1%) poor quality of sample, five (3.6%) insufficient biopsy, three (2.1%) inappropriate fixative, two (1.4%) both insufficient and poor-quality sample and one (0.7%) lack of clinical or radiographic details. Comparison between central and peripheral inconclusive reports was not statistically significant (p &gt;0.05).</p> <p><strong>Conclusion:</strong> This study indicates that careful surgical approach is a must along with proper transportation of the biopsy sample and a detailed clinical and radiographic information to avoid inconclusive biopsy reports.</p> Dhan Kumari Manandhar Dipshikha Bajracharya Akanksha Badhu Sushmit Koju Bidhata Ojha Pradeep Bhandari Copyright (c) 2023 Journal of Kathmandu Medical College 2023-06-30 2023-06-30 12 2 75 79 10.3126/jkmc.v12i2.53544 Indocyanine green fluorescence imaging in gastrointestinal surgery <p><strong>Background: </strong>Prevention of post-operative anastomotic leak (AL) is significant challenge for surgeons, with roughly half of all AL cases linked to insufficient vascular supply, often undetectable during anastomosis. Recently, indocyanine green fluorescence (ICG) emerged as promising tool in visceral surgery due to its low cost, ease of use, wide availability, and low toxicity. In gastrointestinal surgery, ICG is primarily used for real-time intraoperative angiography, allowing surgeons to assess anastomotic stumps' perfusion before and after procedure.</p> <p><strong>Objectives: </strong>To assess efficacy of ICG as an adjunct in preventing AL.</p> <p><strong>Methods: </strong>This descriptive study conducted after ethical approval at Kathmandu Medical College Teaching Hospital from 2022 February 15 to 2023 January 30 included 111 patients enrolled via convenience sampling. During operation, surgeon used ICG fluorescence angiography on patients to determine perfusion status, which allowed for evaluation of transection line and post-anastomotic viability. Data were entered in Microsoft Excel sheet 2019 and descriptive analysis done regarding demographic data, changes in the transection line, and post-operative anastomotic leaks.</p> <p><strong>Results: </strong>Total 111 patients with age 55.41 ± 13.63 years and male-female ratio of 2:1 participated in this study. ICG use resulted in changes to proximal resection margin for five (4.5%) patients. Clinical judgment and ICG fluorescence imaging showed a difference in bowel transection line of 0.5-1.5 cm. None of the patients who underwent proximal resection margin revision with the assistance of ICG experienced post-operative anastomotic leaks.</p> <p><strong>Conclusion: </strong>ICG fluorescence can be used as an adjunct in determining the viability of anastomosis and prevent post-operative anastomosis leak.</p> Yugal Limbu Prashanta Pudasaini Sujan Regmee Bidur Prasad Acharya Roshan Ghimire Dhiresh Kumar Maharjan Prabin Bahadur Thapa Copyright (c) 2023 Journal of Kathmandu Medical College 2023-06-30 2023-06-30 12 2 80 86 10.3126/jkmc.v12i2.45509 Radiographic evaluation of preoperative periapical status in teeth with apical abscess <p><strong>Background:</strong> The presence of preoperative periapical lesion is a significant prognostic factor that influences the outcome of endodontic treatment. Radiographic evaluation of periapical status is important for diagnosis, treatment, and prognosis of periapical lesion.</p> <p><strong>Objectives:</strong> To radiographically compare and evaluate the preoperative periapical status using periapical index (PAI) in teeth with acute and chronic apical abscess.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted in Chitwan Medical College, between 2022 February to 2022 May using nonprobability convenience sampling technique. Forty-eight periapical radiographs with a diagnosis of apical abscess {24 acute apical abscess (AAA) = Group 1; 24 chronic apical abscess (CAA) = Group 2)} were included for evaluation. Four observers (Three endodontists and one oral radiologist) evaluated the periapical status on radiographs and scored them according to PAI scoring system. Statistical analysis was done using the Mann-Whitney U test and SPSS v.22.</p> <p><strong>Results:</strong> The most common PAI score for teeth in Group 1 was three (13, 54.20%) with mean PAI score = 3.21 and in Group 2 the score was four (13, 54.20%) with mean PAI score = 3.79. Analysis of PAI scores found significant differences (p = 0.009, p &lt;0.05) between groups. The distribution of PAI varied according to apical diagnosis (p &lt;0.05). Intraobserver and Interobserver agreement values demonstrated good self-agreement and interobserver agreement.</p> <p><strong>Conclusion:</strong> Teeth with CAA were more likely to have higher PAI scores and therefore, periapical radiograph and PAI scoring system can be used effectively for the evaluation of preoperative periapical status in teeth with apical abscess.</p> Sanjeeb Chaudhary Harender Singh Archana Gharti Govind Kumar Chaudhary Abhishek Gupta Copyright (c) 2023 2023-06-30 2023-06-30 12 2 87 95 10.3126/jkmc.v12i2.53545 Psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases <p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and imparts substantial economic burden on individuals and health systems. Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population.</p> <p><strong>Objectives:</strong> To assess the psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases.</p> <p><strong>Methods:</strong> Analytical cross-sectional research was conducted in medical outpatient department of Kathmandu Medical College Teaching Hospital from 2019 Nov 20 to 2020 May 20 after institutional ethical clearance. Total 185 individuals diagnosed with chronic obstructive pulmonary disease seeking medical care were included in the study by using purposive sampling. Data collection was done through face-to-face interview technique using Hopkins Symptoms Checklist-10 and Brief Cope inventory. The collected data were analysed using SPSS software version 20.</p> <p><strong>Results:</strong> Based on a cut-off value of ?1.85 of Hopkins symptoms checklist-10, almost all (180, 97.3%) patients had mental distress. Frequently used approach coping subscales by the patients were emotional support (82, 44.2%), religion (81, 42%), planning (80, 41.8%), and active coping (80, 41.7%). Similarly, mostly used avoidance coping were: denial (80, 41.8%), venting (79, 41.1%), and self-blame (78, 40.6%).</p> <p><strong>Conclusion:</strong> Almost all patients living with chronic obstructive pulmonary diseases had predicted mental distress and they were using both approach and avoidance coping measures.</p> Sony Shrestha Narayani Paudel Puspa Parajuli Copyright (c) 2023 2023-06-30 2023-06-30 12 2 96 100 10.3126/jkmc.v12i2.60344 Assessment of rational use of drugs using World Health Organisation’s indicators in a government hospital of central Nepal <p><strong>Background:</strong> Irrational practice of medicines use is a serious problem of health care setting. </p> <p><strong>Objectives: </strong>The primary aim of this study was to assess rational use of drug (RUD) at a government hospital of central Nepal using World Health Organisation (WHO) core drug use indicators.</p> <p><strong>Methods:</strong> This descriptive, cross-sectional study was conducted from 2022 November to December at Hetauda Hospital after ethical clearance. A total of 500 prescriptions were taken retrospectively by using systematic sampling method for prescribing indicators whereas 100 patient interviews were conducted prospectively to study patient care indicators. For facility-based indicators different departments of the selected hospital were visited to collect the data.</p> <p><strong>Results:</strong> The mean values of prescribing indicators of RUD in the surveyed hospital compared with WHO values for prescription of generics, antibiotics, and injections was found to be 6.3% (n = 119) vs.100%; 28.4% (n = 142) vs. 20-26.8%; and 1.2% (n = 6) vs. 13.4-21.1% respectively. Another discrepancy reported was regarding the mean number of drugs per prescription which was found to be more than the WHO optimal value (3.77 vs. 1.6-1.8). The average consultation time and dispensing time was found to be 5.52 ± 4.49 minutes vs. 10 minutes and 111 ± 60.2 seconds vs. more than 180 seconds, respectively as compared with WHO value.</p> <p><strong>Conclusion:</strong> According to the WHO/RUD core drug use indicators, rational medicine use is not attained in most prescribing and patient care components. It is recommended that health institutions should co-operate to promote the judicious use of medications.</p> Satish Deo Aashma Dahal Biswash Sapkota Copyright (c) 2023 2023-06-30 2023-06-30 12 2 101 106 10.3126/jkmc.v12i2.60345 Antibiotic susceptibility pattern of bacterial isolates from soft tissues infections among patients visiting a tertiary care centre <p><strong>Background</strong><strong>: </strong>Pus is a thick, white to yellow fluid that consists of dead leucocytes, cellular debris, necrotic tissues, and bacteria characteristic of pyogenic infections that may be exogenous or endogenous. The resistant pathogens isolated from wound infections have become a global challenge and a grave threat to the public health worldwide.</p> <p><strong>Objectives</strong><strong>: </strong>To characterise the bacterial isolates from clinical specimens of pyogenic wound infections and to determine the antibiotic susceptibility test.</p> <p><strong>Methods</strong><strong>: </strong>A hospital-based, descriptive, cross-sectional study was carried out after ethical clearance in the department of microbiology, Nobel Medical College from 2021 May to 2022 January. Various clinical specimens were obtained by convenience sampling. Identification and antibiotic sensitivity test were done as per the standard microbiological procedures. Data were analysed by SPSS v.20.</p> <p><strong>Results: </strong>Out of 1704 sample collected, 901 (52.8%) showed growth in which 893 (52.4%) showed monomicrobial growth and 8 (0.46%) showed mixed growth. Among the samples, females outnumbered males (F: M-1.4:1) and majority of infection were observed in age group between 21-30 years. Most of the isolates were Gram-negative bacteria (462, 50.8%) which were mostly sensitive to amikacin. The most predominant organism was <em>Staphylococcus aureus</em> (427, 47%) which was 100% sensitive to vancomycin and highly resistant to ampicillin (341, 79.8%).</p> <p><strong>Conclusion: </strong>The dryness in the pipeline of new antibiotic and emergence of multidrug resistant strains have pointed the current need towards active microbial surveillance in all clinical settings and prudent use of antibiotics.</p> Kewal Shrestha Kumari Ragani Yadav Ganesh Kumar Singh Prabhat Kumar Copyright (c) 2023 2023-06-30 2023-06-30 12 2 107 112 10.3126/jkmc.v12i2.60346 Kimura’s disease: A case report of recurring multiple swellings in the periauricular region <p>Kimura’s disease is a rare, benign chronic inflammatory disorder that manifests with abnormal proliferation of vascular endothelium and lymphoid tissues. Ten years back, then 15-year-old Nepali (Asian) male presented to the otorhinolaryngology department with swelling of approximately 5 cm x 6 cm on the left and 6 cm x 7 cm on the right post-auricular region. The patient consulted for cosmetic reasons. Fine-needle aspiration cytology revealed Kimura’s disease. A high index of suspicion is needed to diagnose this disease. Early diagnosis can have proper treatment and treatment of co-existing conditions related to this disease.</p> Meera Bista Raunak Bista Mamata Lakhey Shirjan Gautam Copyright (c) 2023 2023-06-30 2023-06-30 12 2 113 115 10.3126/jkmc.v12i2.60347 Congenital chylothorax in a preterm infant with non-immune hydrops: A case report with literature review on treatment options <p>Congenital chylothorax is rare with an incidence of 1:10,000-24,000 live births. Congenital chylothorax occurs in lymphatic disorders, heart diseases, cancers, chromosomal abnormalities, tracheoesophageal fistula, etc. Acquired causes are due to surgical thoracic duct trauma. Many cases of chylothorax are idiopathic. The case fatality rate is 15% to 57% and reaches 98% in hydrops foetalis. There is no set standard of treatment for congenital chylothorax. Prenatally, thoracentesis or pleuro-amniotic shunts are done. Postnatally, management of cause, drainage, dietary changes, Octreotide, and Sildenafil have variable results. Pleurodesis, pleuroperitoneal shunt, abrasion, thoracic duct ligation, and anastomoses are surgical options.</p> Ganendra Bhakta Raya Srijana Basnet Sitaram Nyaupane Copyright (c) 2023 2023-06-30 2023-06-30 12 2 116 123 10.3126/jkmc.v12i2.60349 Combined endoscopic approaches in management of complicated forgotten double J stent: A case report <p>Forgotten Double J (DJ) ureteric stent with encrustation is a source of morbidity and unrequired admission. It is prevalent due to a lack of patient education and follow-up in third-world countries like Nepal. A case is reported of 30 years gentleman who had underwent right pyelolithotomy for large staghorn calculus and placement of DJ stent after surgery. The patient presented with encrusted, retained DJ stent which was managed with endoscopic combined intrarenal surgery with retrieval of the forgotten DJ stent.</p> Ganesh Kumar Giri Tunam Khadka Pasang Sherpa Erena Pradhan Aayam Adhikari Prajwal Paudyal Copyright (c) 2023 2023-06-30 2023-06-30 12 2 124 127 10.3126/jkmc.v12i2.60348