Journal of Lumbini Medical College <p>Journal of Lumbini Medical College (JLMC) is a biannually, peer reviewed, open access, Scientific Medical Journal published in English by Lumbini Medical College in Palpa, Nepal. The journal is also available on its own website at <a title="JLMC" href="" target="_blank" rel="noopener"></a></p> en-US The <strong>Journal of Lumbini Medical College</strong> (JLMC) publishes open access articles under the terms of the <a href="" target="_blank">Creative Commons Attribution</a>(CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.<p>JLMC requires an exclusive licence allowing to publish the article in print and online.</p><p>The corresponding author should read and agree to the following statement before submission of the manuscript for publication,</p><p><strong>License agreement</strong><br />In submitting an article to Journal of Lumbini Medical College (JLMC) I certify that:</p><ol start="1"><li>I am authorized by my co-authors to enter into these arrangements.</li><li>I warrant, on behalf of myself and my co-authors, that:</li><ul><li>the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;</li><li>I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to JLMC are not in breach of any other obligation;</li><li>the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;</li><li>I/we have taken due care to ensure the integrity of the article. 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For the avoidance of doubt it is stated that sections 1, 2, and 3 of this license agreement shall apply and prevail.</li></ol><p>Please visit <a href="">Creative Commons</a> web page for details of the terms.</p> (Dr. Deepak Shrestha) (Sioux Cumming) Sun, 14 Nov 2021 19:20:42 +0000 OJS 60 ‘Publish or Perish’ Trend: Fueling the Predatory Journals <p>In the past, journals were published only in the print, and the only way to access them was through the library. However, today we can easily access journals and articles with a click. There are more online journals which have made it possible and feasible for authors to submit their work.</p> Alok Atreya Copyright (c) 2020 Alok Atreya Wed, 16 Dec 2020 00:00:00 +0000 Estimating the Height of An Individual from The Length of Ulna in Undergraduate Students of a Nepalese Medical College <p><strong>Introduction:</strong> Estimation of height from bones plays an important role in identifying unknown bodies, parts of bodies, or skeletal remains. Multiple anthropometric techniques have been used to estimate stature from skeletal remains by anthropologists, anatomists, and forensic experts. The ulna is a long bone often used for body height estimation, as it is mostly subcutaneous throughout its length and is easily approachable for measurement.</p> <p><strong>Methods:</strong> The present study was carried out on 100 (57 male and 43 female) undergraduate students of a medical college of the age group of 18 to 24 years. The parameters studied were height, length of right, and left ulna. The observations were analyzed by Pearson’s correlation to examine the relationship between the length of ulna and height.</p> <p><strong>Results:</strong>&nbsp;The mean height of males was 174.54 ± 13.32 cm and of females was 156.01±11.19 cm. The mean length of the right ulna was 27.36 ± 2.12 cm (males) and 24.35±1.97 cm (females). The mean length of the left ulna was 27.29 ± 2.13 cm (males) and 24.06 ± 2.18 cm (females). Pearson’s correlation showed a positive and statistically significant (p&lt;0.001) relation between the length of the ulna and the height. The regression equation was derived to estimate the height of an individual from the length of the ulna.</p> <p><strong>Conclusion:</strong> The ulna bone length is an accurate parameter that can be used in estimating an individual's height. The regression equation derived in this study can be of great help to anatomists, clinicians, anthropologists, and forensic scientists.</p> Niraj Pandey, Bandana Padhee Copyright (c) 2020 Niraj Pandey, Bandana Padhee Wed, 22 Jul 2020 00:00:00 +0000 Nairobi Eye: A Clinico-epidemiological Study from A Tertiary Care Center of Central Nepal <p><strong>Introduction: </strong>Periocular paederus dermatitis (Nairobi eye) is characterized by erythematous vesiculo-bullous linear plaque with stinging sensation. It commonly occurs during rainy season. It has been described in people living near agricultural fields due to the potential toxin pederin. This study aims to evaluate the demographic profile and clinical presentation of patients with periocular paederus dermatitis in a tertiary care center.</p> <p><strong>Methods: </strong>This was a descriptive, cross-sectional study evaluating patients attending dermatology and/or ophthalmology department with features consistent with paederus dermatitis involving periocular area from June to August, 2019. Relevant demographic and clinical data were obtained; clinical photographs were taken and histopathology performed among selected patients.</p> <p><strong>Results: </strong>A total of 24 (14.8%) patients had features of Nairobi eye among 162 patients of paederus dermatitis. Majority of the patients were males (1.4:1) with mean age 29.08±13.38 years. The peak time of presentation was the first week of July (37.5%). Mean time period between onset of symptoms and presentation was 3.41±2.01 days. The lesions were unilateral in all cases, with predominant involvement of the right eye (62%). Burning sensation (80%) and itching (60%) were the predominant symptoms while conjunctival hyperemia (41.6%), seropurulent discharge (20.8%) and chemosis (16.6%) were the ocular findings. Most of the patients (n=17, 70.8%) noticed the lesion while waking up in the morning.</p> <p><strong>Conclusion: </strong>The finding of the present study has shown that Nairobi eye is a common presentation during rainy season. Periocular findings with significant intraocular signs were documented to be presenting features among patients with periocular paederus dermatitis.</p> Shekhar KC, Aditi Mishra, Dhiraj KC, Dharmendra Karn Copyright (c) 2020 Shekhar KC, Aditi Mishra, Dhiraj KC, Dharmendra Kan Sun, 16 Aug 2020 00:00:00 +0000 Fine Needle Aspiration versus Fine Needle Capillary Sampling Technique in Cyto-diagnosis of Thyroid Lesions <p><strong>Introduction</strong>: In diagnosis of thyroid lesions, the negative pressure applied during fine needle aspiration cytology (FNAC) frequently produces bloody smears. This results in a compromise in cellular concentration and architecture which may lead to improper interpretation. Fine needle capillary sampling cytology (FNCC), on the other hand, avoids active aspiration as it depends on capillary tension to collect tissue samples in the needle bore. This study evaluated the diagnostic performance of FNAC and FNCC in thyroid lesions.</p> <p><strong>Methods: </strong>A total of 120 patients were included in this study conducted over a duration of 19 months. All thyroid swellings advised for cyto-diagnosis were sampled by both fine-needle aspiration (FNAC) and non-aspiration (FNCC) techniques. The slides were assessed according to the Mair et al. scoring system.</p> <p><strong>Results: </strong>In the FNCC group, 72 (60%) smears were diagnostically superior while 54 (45%) smears were diagnostically superior in the FNAC group. Blood contamination (p=0.003), cellular trauma (p=0.019), and degree of cellular degeneration (p=0.026) were less and cellular architecture (p=0.047) was preserved more in FNCC in comparison to FNAC groups.</p> <p><strong>Conclusion</strong>: This study showed the superiority of FNCC for the interpretation and diagnosis of thyroid lesions. However, the combination of both FNAC and FNCC could maximize the diagnostic yield.</p> Archana Tiwari, Prahar Dahal, Sudeep Regmi, Ramji Rai Copyright (c) 2020 Archana Tiwari, Prahar Dahal, Sudeep Regmi, Ramji Rai Sun, 23 Aug 2020 00:00:00 +0000 Knowledge Regarding Blood Donation among Students of a College in Western Nepal <p><strong>Introduction</strong>: Blood can save millions of lives, and young people are the hope and future of safe blood supply worldwide. This study was conducted with an objective to assess knowledge level regarding blood donation among college students.</p> <p><strong>Methods: </strong>A cross sectional study was conducted at Shree Mandavya Multiple Campus, Palpa, among all years of Bachelor in Business Studies students. Census sampling technique was used and the sample size was 78. A structured questionnaire was used for data collection. Descriptive and inferential statistics (Chi-square) was used for analysis. The level of significance (p) was set at 0.05.</p> <p><strong>Results: </strong>The mean age of the participants was 19.5 years. Majority (67.9%) of the participants were male and the remaining 32.1% were female. Most (87.2%) of them had never donated blood. Few (38.5%) of them had history of blood requirement in the family whereas, 23.1% had blood donation in family. More than half (51.3%) of participants had inadequate level of knowledge regarding blood donation. The study showed that sex (p=0.04), history of self-blood donation (p=0.03) and history of blood requirement in the family (p=0.01) were found statistically significant with level of knowledge regarding blood transfusion.</p> <p><strong>Conclusion: </strong>This study showed that majority of the students had inadequate knowledge regarding blood donation. Thus, it is very important to adopt strategies to sensitize and motivate them towards voluntary blood donation.</p> Sita Bhandari, Parbati Nepal, Bandana Pokharel Copyright (c) 2020 Sita Bhandari, Parbati Nepal, Bandana Pokharel Thu, 10 Sep 2020 00:00:00 +0000 The Role of Aspartate Aminotransferase to Platelet Ratio Index as a Non-Invasive Predictor of Variceal Etiology of Upper Gastrointestinal Bleeding <p><strong>Introduction</strong>: Non-invasive strategies to predict variceal from non-variceal bleeding will be highly beneficial for pre-emptive management of Upper Gastrointestinal Bleeding (UGIB). This study aimed to assess the role of aspartate aminotransferase (AST) to platelet ratio index (APRI) as a non-invasive predictor of variceal etiology of UGIB.</p> <p><strong>Methods: </strong>This was a retrospective descriptive study conducted at Endoscopy Department of Dhulikhel Hospital between January 2017 and December 2019 in patients presenting with acute UGIB. We assessed the diagnostic utility of the APRI score relative to other objective measures by Area Under the Receiver Operating Characteristic (AUROC) curve analysis.</p> <p><strong>Results: </strong>A total of 158 patients with history of UGIB were included in the study. There were total 123 males (77.8%) and the mean age of the patients was 50.3±16.1 years. The APRI score performed well in predicting a variceal etiology of acute UGIB, with AUROC 0.9. When APRI was used at cut-off of 1.3, it had a sensitivity of 84.1% and specificity of 76.8%, a positive predictive value of 70.7% and a negative predictive value of 89.9% while predicting variceal etiology of UGIB at presentation. The relative risk of varices at an APRI cut-off of 1.3 is 17.5 with a p-value of &lt;0.0001.</p> <p><strong>Conclusion: </strong>The present study highlighted that APRI score can be used as an objective metric that helps to predict a variceal etiology of acute UGIB.</p> Ashish Shrestha, Pasanda Sharma, Anjila Lama, Ram Bahadur Gurung Copyright (c) 2020 Ashish Shrestha, Pasanda Sharma, Anjila Lama, Ram Bahadur Gurung Sun, 20 Sep 2020 00:00:00 +0000 Comparison of External Fixation and Supplementary Kirschner-Wires Fixation with Volar Locking Plate for the Treatment of Intra- Articular Distal End Radius Fractures <p><strong>Introduction: </strong>There are controversies regarding the benefit of open reduction and internal fixation with volar locking plates over closed reduction and external fixation along with supplementary Kirschner wires fixation for intra-articular distal end radius fracture.Therefore, this study aimed to compare the outcomes between external fixation along with supplementary Kirschner wires with volar locking plate in the treatment of intra-articular distal end radius fractures.</p> <p><strong>Methods: </strong>This prospective, observational and analytical study was conducted over one and a half years. Forty-seven adults with displaced intra-articular distal end radius fracture were included in the study. Twenty-one cases were treated with closed reduction and external fixation along with supplementary Kirschner wires, whereas 26 patients were treated with open reduction and volar locking plate fixation.</p> <p><strong>Results</strong>: At the end of three months, as per the Green and O’Brien scoring, the mean functional outcome score in the volar plate group was significantly better 80.77(±11.46) than the external fixation group 70.24(±10.66) (p=0.002). However, at the end of six months, the mean score in the volar plate group 86.15(±7.39) was not significantly different from the external fixation group 81.43(±9.63) (p= 0.63). Fracture reduction was achieved and maintained better in the volar locking plate group.</p> <p><strong>Conclusion</strong>: Functional outcome of closed reduction and external fixation along with supplementary Kirschner wires is comparable with open reduction and internal fixation by volar locking plate in treatment of displaced intra-articular distal radius fractures. Radiological correction is achieved and maintained better with volar locking plates.</p> Rajeev Dwivedi, Mandir Khatri, Arjun KC Copyright (c) 2020 Rajeev Dwivedi, Mandir Khatri, Arjun KC Wed, 21 Oct 2020 00:00:00 +0000 Bacteriological Profile of Wound Infection and Antibiotic Susceptibility Pattern of Various Isolates in a Tertiary Care Center <p class="Default"><span class="A3"><strong><span style="font-size: 11.5pt;">Introduction</span></strong></span><span class="A3"><span style="font-size: 11.5pt;">: Wound infection due to various pathogenic microorganisms and the development of resistance to antibiotics is one of the major problems in medical sector. This study aimed to identify the etiological agents of wound infection along with their antibiotic susceptibility. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Methods</strong>: A total of 400 wound swab specimens were collected from the patients visiting a tertiary center in western Nepal over a period of six months. Thus, collected specimens were processed in Microbiology laboratory for isolation of causative agents. Antibiotic susceptibility test was performed for entire isolates by Kirby Baur disc diffusion method. Methicillin-Resistant <em>Staphylococcus aureus </em>was detected by cefoxitin disc diffusion test and Extended-Spectrum Beta-Lactamases producing Enterobacteriaeae by Phenotypic confirmatory disc diffusion test as recommended by Clinical and Laboratory Standards Institute. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Results</strong>: Two hundred and fifty-nine (64.7%) of specimens were infected, giving rise to 269 different isolates. Among these, 163 (60.6%) were gram positive and 104 (38.6%) were gram negative. <em>Staphylococcus aureus </em>(n = 130, 48.3%) was the most predominant bacteria followed by <em>Escherichia coli </em>(n<em>=</em>44, 16.3%), and <em>Klebsiella pneumoniae </em>(n=23, 8.5%). Gentamicin followed by co-trimoxazole was the most effective among the tested antibiotics for <em>Staphylococcus aureus</em>. Gentamicin and ciprofloxacin were shown effective for isolated gram-negative bacteria. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Conclusion: </strong>Fifty-eight (44.6%) of total <em>Staphylococcus aureus </em>were Methicillin-Resistant <em>Staphylococcus aureus </em>positive and 16 (20.7%) of total Enterobacteriaceae were Extended-Spectrum Beta-Lactamases producers. The increased prevalence of Methicillin-Resistant <em>Staphylococcus aureus </em>and Extended-Spectrum Beta-Lactamase suggest rational use of antibiotics on the basis of antibiotic sensitivity results.</span></span></p> Nabina Maharjan, BS Mahawal Copyright (c) 2020 Nabina Maharjan, BS Mahawal Thu, 29 Oct 2020 00:00:00 +0000 Medication Adherence Pattern for Benign Prostatic Hyperplasia: A Cross-Sectional Study <p><strong>Introduction: </strong>Benign prostate hyperplasia is one of the most common diseases and a common cause of lower urinary tract symptoms in aging men. Various disease management approaches to optimize the patient’s long life and efficient status where patient adherence to the prescribed treatment plays a vital role. This study evaluated the medication adherence pattern of the patients to obtain successful treatment outcomes.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted in out-patient department of urology in a tertiary care hospital. Patients diagnosed with benign prostate hyperplasia were interviewed using a structured questionnaire.</p> <p><strong>Results</strong>: The high expenses of medicine, fear of medication, lack of symptomatic relief were factors that showed statistically significant (p &lt; 0.05) difference between adherent and non-adherent group. Similarly, the duration of diagnosis of the adherent group was significantly less than the non-adherent group including the pattern of physical activities (p &lt; 0.05). Adherent group also had more participants working in business and services occupation compared to the non-adherent group.</p> <p><strong>Conclusion</strong>: The general attitude (such as fear of medication and lack of symptomatic relief) is seen as major factors that affect adherent pattern in benign prostate hyperplasia patients. These issues can be solved using proper guidance. However, the cost of medicines also posts an immense issue for the non-adherent group.</p> Jyoti Tara Manandhar Shrestha, Hem Nath Joshi, Prabin Neupane Copyright (c) 2020 Jyoti Tara Manandhar Shrestha, Hem Nath Joshi, Prabin Neupane Fri, 30 Oct 2020 00:00:00 +0000 Microscopic Antegrade Parotidectomy for Different Types of Parotid Tumor <p class="Default"><span class="A3"><strong><span style="font-size: 11.5pt;">Introduction: </span></strong></span><span class="A3"><span style="font-size: 11.5pt;">Salivary gland tumor accounts for about 5% of all the neoplasms of the head and neck. 75% of such tumors occur in the parotid glands. Pleomorphic adenoma is the most common type of benign salivary gland tumor. It tends to recur after inappropriate treatment. Surgery of parotid tumor includes enucleation, superficial parotidectomy and total parotidectomy. Identification and preservation of facial nerve trunk and its branches is very important in parotid surgery. Advancement of microsurgical technique has helped in better visualization, identification and preservation of the facial nerve. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Methods: </strong>This prospective study included twenty-seven patients. Preoperative ultrasonography and fine needle aspiration cytology were done for all cases. Computed tomography/magnetic resonance imaging were performed in some cases when needed. Standard microsurgical technique with the help of microscope was performed for antegrade parotidectomy. Data analysis was done using SPSS version 26.0. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Results: </strong>The patients age ranged from 12 to 78 years. Fifteen (55.6%) patients were female and 12 (44. 4%) were males. Sixteen (59.3%) tumors were located on the right side whereas 11 (40.7%) were on the left side. Most of the tumors (n=18, 66.7%) were pleomorphic adenoma. Two (7.4%) of the patients had temporary facial paralysis which improved with time. Two (7.4%) patients had developed hematoma. Frey’s syndrome was not found in follow-up. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Conclusion: </strong>This study showed low morbidity in parotidectomy using microsurgical techniques. No permanent injury to the facial nerve was found.</span></span></p> Brihaspati Sigdel, Tulika Dubey Copyright (c) 2020 Brihaspati Sigdel, Tulika Dubey Thu, 05 Nov 2020 00:00:00 +0000 Study of Association Between Glycated Hemoglobin and Lipid Profile in Type 2 Diabetes Mellitus in Tertiary Care Center <p><strong>Introduction: </strong>Diabetes is one of the major burdens of non-communicable disease causing morbidity and mortality. Glycated hemoglobin (HbA1c) has been used as a tool to monitor glycemic control in patients with type 2 diabetes mellitus and elevated HbA1c value is considered an independent risk factor for dyslipidemia.</p> <p><strong>Methods: </strong>A total of 120 patients with type 2 diabetes mellitus were enrolled in this cross-sectional study. Means with standard deviation were used for age, height, weight and fasting blood sugar and Pearson correlation test was applied to identify correlation between Glycated hemoglobin (HbA1c) and lipid profile. Comparison of means was done by Student 't' test in parametric data within the two groups. P value less than 0.05 was considered significant.</p> <p><strong>Results: </strong>The mean HbA1c of male and female patients were 8.35±1.77 and 8.65±1.95 respectively. Among patients with good glycemic control, mean total cholesterol and mean high density lipoprotein were higher than poor glycemic control patients. Patients with poor glycemic control had higher mean triglyceride and low density lipoprotein than good glycemic control patients. Correlation coefficient for various components of lipid profile and HbA1c were: total cholesterol (r=0.189, p=0.038, n=120), triglyceride (r=0.418, p&lt;0.01, n=120), low density lipoprotein (r=0.673,p&lt;0.01,n=120) and high density lipoprotein ( r=-0.683,p&lt;0.01, n=120).</p> <p><strong>Conclusion: </strong>There was a significant moderate correlation between HbA1c and lipid profile. Lipid profile values were significantly higher in poor glycemic control than good glycemic control patients. Hence, HbA1c can be considered as a surrogate marker for dyslipidemia in type 2 DM patients.</p> Tilchan Pandey, Jivan Khanal, Krishan Chandra Godar Copyright (c) 2020 Tilchan Pandey, Jivan Khanal, Krishan Chandra Godar Wed, 02 Dec 2020 00:00:00 +0000 Reproductive Health Issues and Use of Family Planning Methods among Married Adolescent Mothers <p class="Default"><span class="A3"><strong><span style="font-size: 11.5pt;">Introduction: </span></strong></span><span class="A3"><span style="font-size: 11.5pt;">Adolescent pregnancy is a major public health concern in low- and middle-income countries. Nepal ranks among the twenty countries with the highest child marriage rates in the world. Adolescent mothers are at higher risk for poorer maternal and neonatal outcomes. This study intended to find the reproductive health issues and use of family planning methods among married adolescent mothers at a tertiary care center in a western part of Nepal. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Methods: </strong>This was a cross-sectional study conducted among adolescent mothers who attended the family planning counselling session at Community Medicine Out-patient Department at a tertiary care center. Pre-tested semi-structured questionnaire was used for data collection and variables were entered in SPSS</span></span><span class="A4"><span style="font-size: 7.0pt;">TM </span></span><span class="A3"><span style="font-size: 11.5pt;">version 16. Descriptive statistics were presented in terms of mean and percentage. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Results: </strong>Among 235 adolescent mothers, the mean age of adolescent mothers was 18.02 years (SD = 1.13). Almost 93.2% had not used any kind of contraceptive methods previously. Limited knowledge, uncomfortable talking about contraception and spousal denial were common reasons for not using contraception. Obstetric related complications were observed in 13.6% and one in ten neonates required neonatal intensive care unit admission during the study period. After the counselling session, six out of ten expressed current choice of long acting reversible contraceptives method in which Jadelle implant was preferred. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Conclusion: </strong>Our study among the adolescent mothers showed that use of family planning methods before pregnancy had been very low. Policies need to focus on meeting the unmet need for family planning among married adolescent girls.</span></span></p> Samata Nepal, Shreyashi Aryal Copyright (c) 2020 Samata Nepal, Shreyashi Aryal Thu, 03 Dec 2020 00:00:00 +0000 Perception of Educational Environment among Nursing Students of Different Colleges: A Cross- Sectional Study <p><strong>Introduction: </strong>Learners are key figures for whom the provision and perception of positive, progressive and encouraging interactive educational environment at any educational institution is very crucial. The study aimed to find the perception of nursing students of two different medical colleges regarding their educational environment.</p> <p><strong>Methods: </strong>A cross-sectional descriptive study was conducted among 190 students through the use of internationally validated, non-culturally specific questionnaire. The responses were made on five points Likert scale scored from 0 to 4. The overall score was interpreted as very poor, plenty of problems, more positive than negative and excellent based on obtained score of 0-50, 51-100, 101-150 and 151-200 respectively. Descriptive statistics and one way analysis of variance test was used to analyze the collected data.</p> <p><strong>Results: </strong>There were 98 (51.6%) participants from College of Medical Sciences and 92 (48.4%) from Lumbini Medical College and Teaching Hospital. The overall score of perception of educational environment were 142.13±14.90 (74.64%) and 144.34±15.59 (76.14%) in the two centers respectively which means more positive than negative perceptions. Only nature of accommodation was found statistically significant with students’ perception of teachers (p = 0.014).</p> <p><strong>Conclusion: </strong>Majority opined a more positive than negative perception towards educational environment. Good communication skills of teachers, knowledgeable teachers, teaching to develop their competence level were some positive perceptions. Whereas, teachers being authoritarian, focus on short term and factual learning, lack of support system were the areas which could be improved.</p> Chandra Kumari Garbuja, Sunita Rana, Pratima Thapa, Mohan Singh Rana Copyright (c) 2020 Chandra Kumari Garbuja, Sunita Rana, Pratima Thapa, Mohan Singh Rana Wed, 09 Dec 2020 00:00:00 +0000 Sex Determination from Radiological Assessment of the Sacrum in Nepalese Population: A Crosssectional Study <p><strong>Introduction</strong>: Human skeleton shows variable degree of sexual dimorphism, but definitive inference can be obtained from only a few bones, sacrum being one of them. The morphometric differences of the bone will be helpful to obstetricians, as it shows special adaptations in females for child bearing. It is also important for physical anthropologists and forensic scientists for sex determination. The aim of this study was to find out whether sex could be determined by using sacral parameters from X-ray images of pelvis.</p> <p><strong>Methods</strong>: The study included antero-posterior X-ray images of pelvis with clearly visible 680 sacra (311 of males and 369 of females) obtained by computer generated random numbers from records in the Department of Radiodiagnosis of a medical college in Nepal. X-ray images with the sacrum suspected for fractures and pathological diseases were excluded. Inbuilt software “CR Konica Minolta Aero DR/CR CS7” was used for measurements.</p> <p><strong>Results</strong>: The mean sacral length and mean transverse diameter of S1 vertebra were higher in males; whereas, mean sacral breadth, mean left ala length, mean right ala length, mean ala length, mean sacral index and mean alar index were higher in females. These differences in sacral parameters between the two sexes were statistically significant (p&lt;0.05). The percentage of bones identified by demarking points of sacral index was 15.17% and 0.32% respectively in the males and the females.</p> <p><strong>Conclusion: </strong>The result of the present study supported determination of sex of an individual from radiological assessment of sacrum.</p> Subina Shrestha, Sudikshya KC, Sumnima Acharya Copyright (c) 2020 Subina Shrestha, Sudikshya KC, Sumnima Acharya Tue, 22 Dec 2020 00:00:00 +0000 Sexual Dimorphism of Maxillary Sinus: A Morphometric Analysis using Computed Tomography <p><strong>Introduction: </strong>Gender determination is the important aspect of forensic science. Most of the bones used for sex determination are badly disfigured and found in incomplete state, thus bones recovered intact are used. Maxillary sinus being recovered intact can be used for gender determination by measuring maxillary sinus dimension through computed tomography (CT). The aim of this study was to assess sexual dimorphism using morphometric maxillary sinus measurements through CT scan.</p> <p><strong>Methods: </strong>This analytical cross-sectional study included CT scan images of 80 patients (40 males and 40 females). Maxillary sinus mediolateral (ML), superoinferior (SI), anteroposterior (AP) linear dimensions and volume were measured. All the measured parameters were then subjected to Student’s t-test to determine mean difference between males and females and discriminative statistical analysis to determine gender.</p> <p><strong>Results: </strong>The mean value of maxillary sinus length, width, height and volume in males on both right and left sides were (3.80±0.175, 3.74±0.209) cm, (2.57±0.317, 2.51±0.295) cm, (3.55±0.338, 3.5±0.286) cm and (17.49±3.909, 16.54±3.274) cm3 respectively and in females (3.67±0.250, 3.64±0.256) cm, (2.37±0.297, 2.34±0.3222) cm, (3.29±0.280, 3.23±0.254) cm and (14.42±2.935, 13.81±2.779) cm3 respectively. The discriminative analysis showed that the accuracy of maxillary sinus measurements was 72.5% in females and 75% of males (overall accuracy = 73.8%).</p> <p><strong>Conclusion: </strong>The maxillary sinus measurements are valuable guide for sex determination with relatively good accuracy rate.</p> Santosh Kandel, Raju Shrestha, Rupesh Sharma, Sanjay Kumar Sah Copyright (c) 2020 Santosh Kandel, Raju Shrestha, Rupesh Sharma, Sanjay Kumar Sah Tue, 29 Dec 2020 00:00:00 +0000 Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients in a Tertiary Hospital of Gandaki Province of Nepal <p class="Default"><span class="A3"><strong><span style="font-size: 11.5pt;">Introduction: </span></strong></span><span class="A3"><span style="font-size: 11.5pt;">Hypertensive retinopathy is one of the major complications of hypertension. Presence of hypertensive retinopathy may be an indicator of presence of other complications too. This study aimed to determine the prevalence and risk factors of hypertensive retinopathy in hypertensive patients in a tertiary care hospital in Nepal. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Methods: </strong>This was a hospital based cross-sectional study conducted among 95 hypertensive patients aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and hypertensive retinopathy was graded according to Keith-Wagener-Barker classification. Statistical analysis was carried out using Epi-info 7. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Results: </strong>The mean age of the study sample was 59.74±15.11 years. The prevalence of hypertensive retinopathy was 38.95%. Among the patients with hypertensive retinopathy, the prevalence of grade I, II, III and IV retinopathies were 7.36%, 17.89%, 10.52% and 3.15% respectively. There was statistically significant association between hypertensive retinopathy and controlled blood pressure and treatment of hypertension. However, there was no statistically significant association between hypertensive retinopathy and gender, duration of hypertension, residence, family history, history of smoking and diet. </span></span></p> <p class="Default"><span class="A3"><span style="font-size: 11.5pt;"><strong>Conclusion: </strong>Uncontrolled blood pressure and untreated patients of hypertension were the significant risk factors for hypertensive retinopathy. Early diagnosis and treatment of hypertension is essential to prevent loss of vision.</span></span></p> Srijana Thapa Godar, Khem Raj Kaini Copyright (c) 2020 Srijana Thapa Godar, Khem Raj Kaini Wed, 30 Dec 2020 00:00:00 +0000 Intensive Physiotherapy Interventions in Speedy Recovery of Sub-acute Stroke: A Case Series <p><strong>Introduction: </strong>Intensive physiotherapy interventions have shown good recovery in stroke if applied to stable patients who can tolerate it. Influence of enriched environment on intensive physiotherapy interventions after acute care has not been studied in low-resource contexts, and therefore, we reported outcome of the interventions in multiple cases with stroke in Nepalese context and cultural background.</p> <p><strong>Case reports: </strong>Three patients in sub-acute stage of stroke were admitted in intensive physiotherapy treatment unit where the environment was therapeutically enriched. The therapist-administered interventions were intensive for each domain of impairment and activity limitations, every day for six days a week. Patients were trained to carry out caregiver-assisted practice or self-practice in enriched environment. Training demonstrated visible and measurable outcome in all cases.</p> <p><strong>Conclusion: </strong>Intensive physiotherapy interventions in an enriched environment promoted good recovery in short period in stroke. The interventions applied, and the principles adopted were based on the established evidence, and therefore findings of this study may support for its feasibility and applicability.</p> Shambhu P. Adhikari, Riju Maharjan, Redisha Jakibanjar, Anushree Balla, Manisha Shrestha, Narendra Shalike, Govinda M. Nepal Copyright (c) 2020 Shambhu P. Adhikari, Riju Maharjan, Redisha Jakibanjar, Anushree Balla, Manisha Shrestha, Narendra Shalike, Govinda M. Nepal Fri, 25 Dec 2020 00:00:00 +0000 Unilateral Phthiriasis Palpebrarum Infestation: A Rare Presentation <p><strong>Introduction: </strong>Phthiriasis palpebrarum is an uncommon eyelid infestation mainly caused by <em>Phthirus pubis </em>also known as crab lice.</p> <p><strong>Case report: </strong>A 16 years male presented with redness, itching and watering of the right eye for one week. On slit-lamp biomicroscopic examination lice and nits anchored to the eyelashes along with seborrheic material accumulation was noted. Lice, partial nits along with matted eyelashes were removed and sent to laboratory for microscopic examination. On follow up visit remaining nits were expunged.</p> <p><strong>Conclusion: </strong>Meticulous slit lamp biomicroscopic examination should be done in all patients presenting with itching of the eyelids in conjunction with clinical findings resembling seborrhea and evidence for Phthiriasis palpebrarum should be looked for.</p> Vinit Kumar Kamble, Sharad Gupta, Reena Yadav, Sanjay Kumar Singh, Bipin Bista, Nirajan Sah Copyright (c) 2020 Vinit Kumar Kamble, Sharad Gupta, Reena Yadav, Sanjay Kumar Singh, Bipin Bista, Nirajan Sah Tue, 29 Dec 2020 00:00:00 +0000 Phytobezoar: A Rare Cause of Small Bowel Obstruction <p><strong>Introduction: </strong>Small bowel obstruction is a common condition encountered in surgical practice. However, obstruction due to phytobezoars is a rarity. Until recently, phytobezoars were incidental findings during surgery. However, advances in imaging have eased the diagnosis by precisely identifying and locating the etiology.</p> <p><strong>Case report: </strong>An 86-year-old lady presented to the emergency room with abdominal pain, distension, and inability to pass stool and flatus. Subsequent workup showed features of small bowel obstruction complicated with sepsis and worsening of preexisting respiratory co-morbidity. Exploration revealed a phytobezoar causing the bowel obstruction.</p> <p><strong>Conclusion: </strong>Phytobezoar, though uncommon, should always be thought of while treating a case of intestinal obstruction in the elderly age group. Surgery is the mainstay of treatment. However, preexisting co-morbid condition plays avital role in the outcome.</p> Rajiv Nakarmi, Muza Shrestha, Sunder Maharjan Copyright (c) 2020 Rajiv Nakarmi, Muza Shrestha, Sunder Maharjan Wed, 30 Dec 2020 00:00:00 +0000