Journal of Kathmandu Medical College

Flipped classroom: A promising teaching approach for medical education

Megha Pradhan — 2022-07-01

No abstract available.

Amplatzer atrial septal defect occluder device embolisation to right pulmonary artery

Prabhat Khakural — 2022-07-01

Atrial septal defect is a common congenital acyanotic heart disease which is treated with either surgical closure or transcatheter closure. Although surgical closure is gold standard, transcatheter device closure is gaining popularity worldwide and in Nepal due to favourable outcome in selected patients. Device migration following transvenous closure of atrial septal defect is a common problem but its lodgment in right pulmonary artery is a rarely encountered and reported clinical scenario. Here, the authors report a case of 42-year-old female who had an embolisation of Amplatzer septal occluder to right pulmonary artery requiring urgent surgical intervention to retrieve the device.

Panuveitis after covishield vaccination in an undiagnosed immunocompromised patient: A rare case report from Nepal

Bipin Bista — 2022-07-01

With the emergence of vaccines for the novel coronavirus, a new ray of hope came into human society. Yet the adverse effects of vaccination on some candidates without allergic tests might cause a detrimental change in the future. An interesting case of panuveitis in a 34-year-old male after the ChAdOx1 nCoV19 (covishield) vaccination is reported here. The respective management of the patient was done after comprehensive ocular and systemic evaluation. It is understood that vaccination is vital in controlling this pandemic, but the immunologic response due to this novel vaccine is also a concern.

Effectiveness of local injection of autologous blood versus corticosteroid in treatment of tennis elbow

Tanup Prasai — 2022-07-01

Background: Tennis elbow or lateral epicondylitis is characterised by pain and tenderness at the lateral epicondyle of humerus. There are various treatment modalities recommended, but there is no universally accepted therapeutic modality yet.
Objectives: To compare the functional outcomes of local injection of corticosteroid versus autologous whole blood for tennis elbow.
Methods: This was a non-randomised trial conducted from May 2020 to January 2021 after ethical clearance. Patients attending orthopaedic surgery outpatient department, Kathmandu Medical College with lateral epicondylitis of the humerus were included by convenience sampling into corticosteroid group or autologous blood injection group based on whether they presented on odd or even calendar days respectively. There were 38 patients in corticosteroid group and 36 patients in autologous blood group. The visual analogue scale (VAS) and Nirschl staging system were calculated before injection, and then at one week, six weeks, and six months after injection.
Results: Patients in both groups showed statistically significant decrease in pain from preinjection scores on both VAS and Nirschl scale at all follow-ups. There was no statistically significant difference between the two groups up to six weeks. At six months, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group on both scoring systems.
Conclusion: Both groups showed comparable improvement up to six-week follow-up. Autologous blood injection group had significantly better improvement at six months. Autologous blood injection was more effective than corticosteroid injection at midterm follow-up, and had lower recurrence rate.

Comparing the outcome of lateral versus posterior approach for hemi-replacement arthroplasty for neck of femur fracture: A randomised controlled trial

Pradeep Kafle — 2022-07-01

Background: Among commonly used approaches, posterior approach (Moore’s) results in better regain of function as it require less muscle dissection, while the lateral approach (Hardinge’s) has a lower risk of dislocation.
Objectives: To compare the functional outcome between lateral and posterior approaches for hemiarthroplasty.
Methods: This parallel design randomised controlled trial of equivalence (allocation ratio 1:1) was conducted in the department of orthopaedics, BP Koirala Institute of Health Sciences with institutional ethical clearance. Fifty eligible patients of >60 years with isolated traumatic displaced neck of femur fracture, presenting during study period from September 2017 to August 2019, were conveniently recruited and randomly allocated by using computerised Excel random number generation technique to undergo hemi-replacement arthroplasty either by lateral approach (N = 25) or by posterior approach (N = 25) and were evaluated at six weeks, three months, six months, and twelve months. Final statistical analysis was done using SPSS v.20 software among 45 patients because four deceased and one was lost to follow-up. The p-value <0.05 was considered statistically significant.
Results: The functional outcome as measured by the Modified Harris Hip score at one year was 83.78 ± 5.89 for lateral approach and 80.40 ± 7.56 for posterior approach group (p = 0.102). The hip pain, mean blood loss, operative time, and prothesis size was similar between the two approaches.
Conclusion: The study showed that there was no significant difference between the two approaches for hemireplacement arthroplasty in terms of mean operating time, hip pain, and functional outcomes.

Maxillary labial frenulum attachment among patients visiting a tertiary level hospital of Nepal

Samarika Dahal — 2022-07-01

Background: The maxillary labial frenum is frequently inserted in the mucogingival junction. However, it may show variation in attachment. Despite the fact that an aberrant labial frenum has been associated to a range of syndromic and non-syndromic disorders, it is frequently overlooked during routine intraoral examinations.
Objectives: To find the prevalence of types of maxillary labial frenum attachment in patients visiting tertiary hospital in Nepal.
Methods: This analytical cross-sectional study comprised of 140 patients visiting the dental outpatient department of Tribhuvan University Teaching Hospital from December 23, 2021 to March 13, 2022. Investigators assessed the patient’s frenum insertion in the dental chair with the lip softly pulled away from the alveolar process in a nearly horizontal direction under good lighting. Data were entered and analysed statistically using SPSS.v21 where mean, standard deviation, frequency, and percentage were calculated depending upon the nature of data. Fisher’s exact test was done to determine the association of age category and sex with the types of frenulum attachment.
Results: Most of the individuals (83, 59.3%) had the mucosal type of frenum followed by gingival (46, 32.9%), papillary (9, 6.4%), and least with papillary penetrating (2, 1.4%). Age and sex did not show any association with types of frenulum attachment.
Conclusion: The insertion level of the labial frenum may vary, implying the significance of careful assessment during an intraoral examination. It also suggests that in presence of the abnormal attachment, an effective treatment approach planned timely could prevent gingival and interdental papilla pathological alterations.

Ultrasound correlation of transcerebellar diameter with last menstrual period for gestational age in second and third trimester of pregnancy

Smriti Mulmi — 2022-07-01

Background: Foetal biometry is useful modality in assessment of gestational age (GA) for good obstetric outcome.
Objectives: To compare ultrasonographic measurement of transverse cerebellar diameter (TCD) with other previously established foetal ultrasound biometric parameters.
Methods: An analytical cross-sectional study was conducted from August 2020 to February 2021 in Department of Radiology at Kathmandu Medical College after ethical clearance. Convenience sampling technique was utilised to include all pregnant women in second and third trimester with known last menstrual period (LMP). Written informed consent was taken from those willing to participate. Congenital malformations, multiple pregnancies, irregular menstrual cycle, and maternal illness were excluded. Data were entered and analysed by using SPSS v.22. Descriptive statistics like mean, standard deviation, and percent were used. Inferential statistics (t- test and Pearson correlation) was also used to see the correlation between different variables.
Results: Among 100 participants who participated in the study, 63 (63%) were primigravida with singleton pregnancy without any congenital anomalies. The mean foetal heart rate was 144.9 ± 13.6. The mean GA based on LMP, TCD, and other parameters were 30.86 ± 7.76 weeks, 31.07 ± 8.45 weeks, and 29.75 ± 6.61 weeks respectively. In 15-28 weeks, all parameters had nearly equal r-values. Among all, TCD revealed highest correlation (0.888). In 29-40 weeks, there was considerable difference in r-values. The second most accurate correlation was seen with head circumference (r = 0.874).
Conclusion: TCD being stable parameter not affected by foetal growth status maybe preferred over other parameters in estimating foetal gestational age.

Clinical profile of COVID-19 patients admitted in a tertiary care hospital of Nepal: A descriptive cross-sectional study

Sujan Chandra Poudel — 2022-07-01

Background: Coronavirus disease 2019 (COVID-19) causes mild to severe respiratory illness and is associated with ICU admission and mortality. Since data regarding clinical profile of COVID-19 patients in Nepal is still lacking, it is important to study clinical behaviour of COVID-19 in Nepal. In this study the demographic profile, clinical features, lab parameters, and outcomes in hospitalised COVID-19 patients in a tertiary care hospital are reported.
Objective: To assess the clinical profile in terms of clinical symptoms, laboratory parameters, and outcome of COVID-19 admitted patients in a tertiary care hospital.
Methods: This is a descriptive cross-sectional study conducted at KMCTH, from June 1, 2021 to July 31, 2021 after taking ethical clearance from institutional review committee. All patients infected with COVID-19 admitted in this hospital, from June 1, 2021 to July 31, 2021 were included by convenience sampling. Data were collected, and entry and analysis were done in Microsoft Excel Sheet 2007.
Results: During the study period, 245 COVID-19 patients were admitted and were included in the study. The median age of the patients was 55 years, the mean age was 55 ± 17 years, and 139 (56.74%) were male. The common presenting complaints were cough in 180 (73.47%) followed by fever in 176 (71.84%) patients. Most common comorbidity found was hypertension in 89 (36.33%), followed by diabetes in 50 (20.44%).
Conclusion: In this single-centred study, the characteristic features included presence of comorbidities, higher level of inflammatory markers, and high mortality rate in severe to critical hospitalised COVID-19 patients.

Association of optic nerve sheath diameter with direct intracranial pressure measurement in neurosurgical patients

Bidur KC — 2022-07-01

Background: Invasive intracranial devices are gold standard for measurement of intracranial pressure (ICP), however optic nerve sheath diameter (ONSD) by using ultrasound is emerging lately as a non-invasive bedside tool.
Objectives: This study aimed to find association between ONSD and invasive ICP and also to find optimum cut off of ONSD to detect raised ICP.
Methods: An analytical observational study using a convenience sample was done at Department of Neurosurgery, Kathmandu Medical College from March 1, 2022 and March 31, 2022. The ONSD of both the eyes were measured using ultrasound in patients with ventriculostomy catheter. Simultaneous ICP was also recorded. The Pearson’s correlation coefficient was used to assess an association between the ONSD and direct ICP measurement.
Results: Total of 40 ONSD measurements were done in 12 neurosurgical patients. Age of patients ranged from 17-75 years with mean age of 47.33 ± 17.67 years with male to female ratio of 1:2 respectively. Pearson’s correlation coefficient of ONSD and invasive ICP was 0.86 (p-value <0.001) showing significant correlation. Receiver operator characteristic curve generated an area under the curve with value of 0.93 (95% of confidence interval = 0.86 to 1.00). The ONSD cut off value of >5 mm predicted ICP >20 mmHg with a sensitivity of 92.3% and specificity of 85.2%.
Conclusion: There exists a significant correlation between ONSD and invasive ICP with optimal cut off >5 mm to detect raised ICP.

Knowledge and perception towards COVID-19 vaccination among health care workers at a tertiary care centre

Subash Pant — 2022-07-01

Background: Coronavirus disease 2019 (COVID-19) has caused an enormous impact on the health care system. The most effective way of controlling infectious diseases like COVID-19 is often vaccination. Health care workers have a key role in reducing the burden of the pandemic, role modeling preventive behaviours, and helping to vaccinate others.
Objective: The aim of the study was to find the knowledge, and perception towards COVID-19 vaccination among health care workers.
Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Teaching Hospital from 1st June 2021 to 30th June 2021. Ethical clearance was taken from the institutional review committee (Ref. 2005202101). Convenience sampling was done. All the health care workers of the hospital who provided consent for the study were included in the study. Collected data were entered and analysed using SPSS v.24.
Results: In this study, 270 health care workers were included, out of which 90 (33.3%) were male and 180 (66.7%) were female. The majority (176, 65.2%) of the health care workers got vaccinated to boost their immunity. The most common factor causing COVID-19 vaccine hesitancy in health care workers initially was the safety of the vaccine (133, 49.3%).
Conclusion: The majority of the participants had good knowledge and positive perception of the COVID-19 vaccines. It demonstrates the need for effective education and communication designed to enhance knowledge about the COVID-19 vaccine and to teach vaccine counselling skills to the health care workers.

The Effect of Risperidone and Olanzapine on blood glucose levels and lipid profile among individuals with schizophrenia

Vijay Kaul — 2022-07-01

Background: Treatment of schizophrenia requires use of antipsychotics for considerable time. Studies established that patients have risk of metabolic side effects.
Objectives: To study fasting blood glucose levels and lipid profile in schizophrenic patients and to see that same was present in study population.
Methods: This study was conducted at psychiatry outpatient department, Nobel Medical College and Teaching Hospital Kanchanbari Biratnagar from October 2018 till august 2019 after due approval from college ethics committee. A total of 50 consenting drug naive schizophrenia patients 17- 60 years of age, with no comorbidity, were divided alternatively into two groups. group 1 was treated with olanzapine, group 2 with risperidone for eight weeks. With flexible dosage for ease of the therapy and individual patient requirement. Fasting blood glucose and lipid profile was measured at day baseline, four, eight weeks.
Results: There was rise of fasting blood glucose in both groups but more in olanzapine group with no statistically significant intergroup difference (The p-value after eight weeks was 0.504). In lipid profile, mean total cholesterol levels were higher in the group 1, (p = 0.005 after eight weeks). Triglycerides, on intergroup comparison significant difference (p = 0.002) was noted. Higher values in group 1 were recorded. However, very low-density lipoprotein was elevated (p = 0.003) in group1 only.
Conclusion: olanzapine and risperidone cause non-significant rise in fasting blood sugar. Olanzapine caused statistically significant rise of total cholesterol, triglycerides, very low-density lipoprotein as compared to risperidone.

Analysis of smile pattern at a tertiary care centre

Kalit Raj Joshi — 2022-07-01

Background: The treatment of the aesthetic region of mouth is complicated. Knowledge of the smile pattern which includes smile line, smile curvature, smile arc, labiodental relation, and tooth exposed determines the success of treatment. This is helpful in the diagnosis and treatment planning phases of aesthetic dentistry.
Objectives: To determine the smile pattern in aesthetic region and to compare the different smile patterns.
Methods: This analytical cross-sectional study was done in the department of Prosthodontics and Maxillofacial Prosthesis, Universal College of Medical Sciences, Nepal from 15th October 2021 to 15th March 2022. A total number of 355 samples were taken by convenience sampling technique. After receiving participant’s consent, study was carried out using a digital camera. The camera was set to primarily capture the area between nose and chin, with lens parallel to the apparent occlusal plane of the participants. For study purpose, individuals were told to sit and hold head normally with their head in level with Frankfort horizontal plane.
Results: The total number of participants were 355 out of which 153 (43.09%) were male and 202 (56.91%) were female. In the smile line pattern, the “Average” smile line was prevalent in a maximum number of participants (223, 62.8%) followed by the high and low smile lines. There was a significant relationship between the smile arc, labiodental relationship, and the tooth displayed.
Conclusion: The findings of this study determines the smile pattern of this region, thus this will be helpful in the diagnosis and treatment planning during the treatment.

Experience-complexity gap: A new challenge for nursing

Ahmed Lateef Alkhaqani — 2022-07-01

Hospitals and health systems face a new shortage of nursing staff: a lack of experience. As older nurses retire and the influx of new nurses continues to grow, the net effect is a decline in the overall experience of the nursing workforce. At the same time, the provision of health care is becoming increasingly complex; call this phenomenon “the experience-complexity gap.” If not addressed, the gap between experience and complexity will widen and put quality and safety.