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&nbsp;<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> en-US <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> (Dr. Abhinav Vaidya) (Sioux Cumming) Mon, 04 Nov 2019 08:11:18 +0000 OJS 60 Transitioning into obesity <p>Not available.</p> Arti S. Pandey ##submission.copyrightStatement## Thu, 29 Aug 2019 06:38:29 +0000 Preemptive use of oral gabapentin or pregabalin for acute postoperative pain following lower limb orthopaedic surgery under spinal anaesthesia <p><strong>Background:</strong> Postoperative pain is a major cause of perioperative morbidity and functional impairment. Preemptive&nbsp;analgesia is an analgesia regimen instituted before the surgery, to desensitize the pain pathways. Pregabalin and&nbsp;gabapentin have been claimed to be effective in reducing postoperative pain without significant alterations in&nbsp;hemodynamics.</p> <p><strong>Objectives:</strong> This study was conducted to compare the effectiveness of pregabalin and gabapentin in reducing&nbsp;postoperative pain, total opioid consumption, postoperative nausea and vomiting and sedation in patients undergoing&nbsp;lower limb orthopaedic surgeries under spinal anaesthesia.</p> <p><strong>Methodology:</strong> Eighty patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia were divided&nbsp;into two groups, to either receive 300mg gabapentin or 150mg pregabalin, one hour before surgery. The patients were&nbsp;evaluated at one, two, six, 12 and 24 hours postoperatively and Visual Analogue Scale score for pain, postoperative nausea&nbsp;vomiting, and sedation score were monitored. Tramadol 50 mg was used as rescue analgesic and total consumption over&nbsp;24 hours was recorded.</p> <p><strong>Results:</strong> The mean duration of postoperative analgesia was significantly higher with pregabalin (282±106 minutes&nbsp;versus 234 ± 97minutes, p=0.009). The sedation score was significantly higher with pregabalin in the first hour (p=0.001).&nbsp;The total tramadol consumption was higher with gabapentin; however, it was statistically insignificant. The occurrence&nbsp;of postoperative nausea and vomiting was comparable between the groups. Minor adverse effects such as dizziness,&nbsp;sedation and headache were observed in both groups.</p> <p><strong>Conclusion:</strong> Pregabalin 150 mg orally significantly increases the duration of postoperative analgesia than gabapentin&nbsp;300mg following lower limb orthopaedic surgeries. Although sedation is frequently observed, it doesn’t alter the&nbsp;hemodynamics and thus, may be used safely.</p> Utsav Acharya, Aashish Ghimire, Balkrishna Bhattarai, Satyendra Narayan Singh, Jagat Narayan Prasad, Rajiv Maharjan ##submission.copyrightStatement## Sat, 10 Aug 2019 00:00:00 +0000 Perception of nurses regarding family needs of critically ill patients in a tertiary hospital of Kathmandu: A cross-sectional study <p><strong>Background:</strong> Getting serious illness and being admitted in critical care unit is always stressful to patient and family&nbsp;members. Meeting the needs of family members of patients in the intensive care unit is a primary responsibility of&nbsp;intensive care unit staff and an important criterion in assessment of quality of care.</p> <p><strong>Objectives:</strong> The aim of this study was to assess the family members’ needs of critically ill patients as perceived by nurses.</p> <p><strong>Methodology:</strong> A descriptive cross sectional study was conducted among 50 nurses from different critical care units<br>of Kathmandu Medical College Teaching Hospital using purposive sampling technique. Structured questionnaire was&nbsp;developed by referring to “Critical Care Family Needs Inventory”in our context for data collection and collected data was&nbsp;analyzed by using Statistical Package for Social Sciences version 16.</p> <p><strong>Results:</strong> The mean age of the respondents was 24.98 ± SD 2.77.Regarding education and experience, 58% respondents&nbsp;had proficiency certificate level and 42% had bachelor level education and mean working experience in critical care unit&nbsp;was 37.54 months. Regarding the importance of family needs, 86% nurses perceived “explanation about the critical care&nbsp;unit environment before admitting the patient in critical care unit” as very important need for the relatives. Likewise, 58%&nbsp;nurses perceived “to know which staff members could give what type of information” and “to be alone at any time” as the&nbsp;least important needs.</p> <p><strong>Conclusion:</strong> The study found that clear explanation about the critical care environment to the relatives is very important&nbsp;to gain co-operation from them in treatment of critically ill patients. Hence, staff of critical care unit needs to be aware in&nbsp;meeting the needs of relatives.</p> Sabita Pandey, Roshanee Shrestha, Narayani Paudel ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Cephalometric evaluation of Brahmins of Kathmandu, Nepal based on Jarabak’s analysis <p><strong>Background:</strong> The cephalometric norms derived from Caucasian population shows a great degree of variation when&nbsp;applied to different population.</p> <p><strong>Objectives:</strong> The present research was performed with the objective of determining cephalometric norms of Brahmins of&nbsp;Nepal based on Jarabak’s analysis, to evaluate the variability between male and female and to compare the cephalometric&nbsp;norms with Caucasians.</p> <p><strong>Methodology:</strong> Lateral cephalogram of 108 non-growing patients which consisted of 63 females and 45 males of<br>Nepalese Brahmins who met our inclusion criteria were traced manually. Thirteen craniofacial parameters of Jarabak’s&nbsp;analysis were measured.</p> <p><strong>Results:</strong> The comparison between Brahmin populations of Nepal with the Caucasian population showed statistically&nbsp;significant difference in ten out of thirteen parameters. The comparison between Nepalese male Brahmins and female&nbsp;Brahmins showed that there were statistically significant differences in eleven out of thirteen parameters.</p> <p><strong>Conclusion:</strong> It can be concluded that there exists sexual and ethnic dimorphism in craniofacial features. The findings&nbsp;of the study highlight the fact that Brahmin population is significantly different from Caucasian population. Females&nbsp;presented with smaller craniofacial variable than male when gender comparison was performed among Nepalese&nbsp;Brahmins male and female. This research has helped to generate knowledge and understanding of craniofacial features&nbsp;of Nepalese Brahmins and derived norms for orthodontic diagnosis and treatment planning.</p> Mona Pokharel, Situ Lal Shrestha ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Use of C-reactive protein level in diagnosis of tubercular pleural effusion <p><strong>Background:</strong> C-reactive protein in both pleural fluid and serum has been found to be higher in tubercular pleural effusion&nbsp;than in other causes of pleural effusion.</p> <p><strong>Objectives:</strong> The main aim of this study was to find out the diagnostic value of C-reactive protein in patients with<br>lymphocytic pleural effusion.</p> <p><strong>Methodology:</strong> A cross-sectional study was conducted in 90 patients with pleural effusion who underwent thoracocentesis&nbsp;at Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. The complete biochemical tests of pleural fluid and&nbsp;serum were performed. The C-reactive protein concentrations of both pleural fluid and serum were then measured from&nbsp;samples from patients with lymphocytic exudative pleural effusion.</p> <p><strong>Results:</strong> Ninety patients with exudative lymphocytic pleural effusion were included. Male patients were 56 (62.2%) and&nbsp;female were 34 (37.8%) with the male to female ratio of 1.64. Mean age of the patients was 51±21.54 (Mean ± Standard&nbsp;Deviation). The pleural fluid C-reactive protein levels in tubercular pleural effusion were higher (48.87±24.19 mg/dl)&nbsp;compared to non-tubercular group (38.30±17 mg/dl; p&lt;0.001). Similarly, the serum fluid C-reactive protein levels in&nbsp;tubercular pleural effusion were higher (29.60±13mg/dl) compared to non-tubercular group (18.14±9.2mg/dl; p&lt; 0.001).&nbsp;The sensitivity of pleural fluid C-reactive protein level in diagnosing tubercular pleural effusion was 86%.</p> <p><strong>Conclusion:</strong> Simple and inexpensive test like C-reactive protein is useful in the diagnostic workup of lymphocytic pleural&nbsp;effusions. High C-reactive protein levels are very suggestive of tubercular pleural effusion.</p> Subash Pant, Sanjeet Krishna Shrestha, Lucky Sharma, Bibechana Shrestha ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Transthoracic echocardiography in patients with chronic kidney disease <p><strong>Background:</strong> Evaluation of cardiac diseases in chronic kidney disease has been rarely investigated in Nepal.</p> <p><strong>Objectives:</strong> Objective of this study is to evaluate cardiac lesions in admitted chronic kidney disease patients.</p> <p><strong>Methodology:</strong> It is a prospective observational study of echocardiography of chronic kidney disease patients from April,&nbsp;2007 to April, 2013 in Nepal Medical College Teaching Hospital.</p> <p><strong>Results:</strong> One hundred chronic kidney disease patients were evaluated. Male to Female ratio was 1.8:1 and age ± SD was&nbsp;46.3 ± 17.2 years. Forty eight percent of the chronic kidney disease patients had left ventricular hypertrophy. Patients with&nbsp;chronic kidney disease with left ventricular hypertrophy group had interventricular septum of 1.5 ± 0.3 cm vs. 1.1 ± 0.1&nbsp;cm (p&lt;0.0001) and posterior wall of 1.1 ± 0.2cm vs. 1.0 ± 0.1cm (p&lt; 0.01) in comparison to chronic kidney disease without&nbsp;left ventricular hypertrophy. Forty one percent had left ventricular systolic dysfunction with left ventricular ejection&nbsp;fraction of 39 ± 9.9 %. Pulmonary arterial hypertension was noticed in 39% patients. Valvular regurgitant lesions were&nbsp;quite common (24.1%) usually as multivalvular lesions (4.4 lesions per patient). Mitral regurgitation was the commonest&nbsp;regurgitant lesion (81%).</p> <p><strong>Conclusion:</strong> Echocardiographic cardiac evaluation is useful to diagnose concomitant cardiac lesions for standard care of&nbsp;chronic kidney disease patients.</p> Balaram Shrestha, Dhiraj Gurung, Sanjib Dhungel ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Investigation of leucinuria as a marker of progression of type 2 diabetes mellitus <p><strong>Background:</strong> The prevalence of diabetes is increasing worldwide leading to an extreme burden in healthcare system.&nbsp;Insulin resistance plays a major role in the pathogenesis of type 2 diabetes mellitus. A number of studies have been done&nbsp;to investigate the role of leucine in insulin resistance. These studies have elucidated raised serum leucine level in type 2&nbsp;diabetes mellitus.</p> <p><strong>Objectives:</strong> The objective of this study was to determine leucine in random urine of type 2 diabetes mellitus and to assess&nbsp;the association of urine leucine with the progression of the disease.</p> <p><strong>Methodology:</strong> An analytical cross-sectional study was carried out in 187 participants after ethical approval. Patients&nbsp;already diagnosed with chronic kidney disease were excluded from the study. Urine microalbumin level was determined&nbsp;by nephelometry technique, HbA1c test was done by high performance liquid chromatoghrapy and urine leucine was&nbsp;detected by thin layer chromatography method.</p> <p><strong>Results:</strong> The mean age of the case population was 55.7±11.6 years and that of control population was 49.98±13.7 years.&nbsp;Out of 105 cases, 15 (14.3%) of them had leucine in random urine where as only 3 (3.6%) of them from control showed&nbsp;the presence of leucine in their urine. There was a significant association observed between diabetic patient and urinary&nbsp;leucine excretion, P = 0.014.</p> <p><strong>Conclusion:</strong> This study indicates an association of type 2 diabetes and urinary leucine excretion. However, presence of&nbsp;leucine in urine does not suggest the progression of the disease.</p> Kabita Khaniya Pokharel, Santosh Pradhan ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Correlation of peak expiratory flow rate with body mass index in school children of a government school of Kathmandu <p><strong>Background:</strong> Peak expiratory flow rate is a reliable data to assess the severity and effectiveness of management in&nbsp;adolescent with asthma. There is no study done in Nepalese children to relate it with the body mass index. The present&nbsp;study tries to find out its relation with age, sex, weight, height, body mass index.</p> <p><strong>Objectives:</strong> To identify the effect of body mass index on peak expiratory flow rate among healthyNepalese school children.</p> <p><strong>Methodology:</strong> Three hundred and ten students of a government school at Kalimati wereincluded in this study. Highest&nbsp;of the three peak expiratory flow rate readings were recorded using Wright’s peak flow meter. Questionnaire were used to&nbsp;find out the pre-existing disease conditions for exclusion from the study population. Weight and height were measured&nbsp;using standardized instruments and body mass index was calculated using formula: weight (kg)/height<sup>2</sup>(m).</p> <p><strong>Results:</strong> Peak expiratory flow rate initially increased with increasing body mass index from -1SD to +2SD and it declined&nbsp;as body mass index increased above +2SD. Pearson’s correlation r was positive with values of 0.7, 0.65, 0.64, 0.35 for&nbsp;height, weight, age and body mass index respectively. Height had highest positive correlation with peak expiratory flow&nbsp;rate while body mass index though had positive but weak correlation with peak expiratory flow rate.</p> <p><strong>Conclusion:</strong> Body mass index is positively correlated with peak expiratory flow rate. However, mean Peak expiratory flow&nbsp;rate initially increases with increasing body mass index and it starts declining as body mass index reaches overweight&nbsp;range.</p> Archana Nepal ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Use of levetiracetam in pediatric refractory status epilepticus <p>Refractory status epilepticus, with persistence of seizures despite initial intravenous benzodiazepine and one secondline&nbsp;intravenous antiepileptic drug occurs in nine percent to 44% of the patients with status epilepticus. Aggressive&nbsp;treatment is needed to control such seizures with drug refractoriness. A case of a 2-year-old boy treated with intravenous&nbsp;levetiracetam with cessation of seizures, averting the need for general anesthesia is reported. Option of using levetiracetam&nbsp;in refractory status epilepticus is suggested.</p> Kashyap Narsingh Shakya, Anwesh Bhatta, Samjhana Phuyal, Arbind Yadav ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000 Craved by heart, carved next to it: Ballistic report of a souvenir bullet casing <p>A bullet which has been lodged in the body encapsulated by dense fibrous tissue for a long time without&nbsp;causing ill effects is a souvenir bullet. The bullet cartridge is divided into 3 parts: bullet, cartridge case holding bullet with&nbsp;gun powder and detonator at the base. Medicolegal consultation was done with Forensic Medicine Department where&nbsp;cartridge case acted as projectile and accidentally got embedded into the chest of the victim. In an attempt of making an&nbsp;ornament from the casing of bullet which was separated from bullet mechanically and gunpowder was partially removed&nbsp;from the bullet case. When he heated the bullet case to melt and mould, the remaining gun powder ignited with release&nbsp;of large amount of gas which resulted in forceful propulsion and acted as the projectile. An oval penetrating keyhole&nbsp;appearance injury measuring 2 cm x 1.5 cm was present on left side of the chest of the victim. The projectile was found&nbsp;just above the 6th rib and was confined within inter-costal muscle. Although late complications may arise from the metallic&nbsp;toxicity from the bullet case showing manifestations like abdominal pain, anorexia, chronic renal failure, abdominal pain, osteomyelitis, and fistula formation in bones, the projectile was left within the body as a souvenir to be intervened in case&nbsp;complications arise during follow-ups, as manipulating it could cause unanticipated therapeutic complications.</p> Jenash Acharya, Geshu Lama, Malshree Ranjitkar, Arbin Shakya ##submission.copyrightStatement## Sun, 18 Aug 2019 00:00:00 +0000