Janaki Medical College Journal of Medical Science

Problem based learning (PBL) in medical education to facilitate student learning

2023-08-25T16:23:25+00:00

Life-long learning and the demand for continuous development of skills, knowledge, and attitudes needed in working life have resulted in a call for new ways to organize learning. The knowledge gained in education becomes quickly outdated and loses its value in real-life scenarios. The skills and knowledge needed in working life cannot all be taught during formal schooling and training. Working life requires multidimensional professional skills with a problem-solving approach and abilities for continuous learning via independent knowledge acquisition and its practical application. Problem-based learning is considered an instructional approach that may solve some of the important issues of medical education, such as the difficulties encountered by students in using the knowledge gained in a clinical setting. Problem-based learning (PBL) courses start with the problems rather than with the exposition of disciplinary knowledge, so that medical students are trained to deal with difficult situations in the future, preparing themselves to become active, independent learners and problem solvers, rather than more or less passive recipients of information. This review is undertaken with an objective to describe innovative problem-based learning and teaching concepts to help facilitate the better learning of real life situations in the classroom and enhance critical thinking among medical students

Clinical Features, Laboratory Parameters, Treatment and Outcome analysis of COVID-19 Patients admitted to a Referral Hospital at Nepalese Terai Region during Second Wave

2023-08-25T14:25:10+00:00

Background & Objective: COVID-19 pandemic has tested health care systems worldwide. The massive wave of infection in Nepal between March to April 2021 overwhelmed the health care institutions throughout the country. This study describes the demographic, clinical, laboratory parameters and outcome of patients hospitalized in a secondary level facility during second wave of infection.

Material and Methods: The data was extracted from admitted patients at Janaki Health Care and Teaching Hospital (JHCTH) with COVID-19, between 9th April to 14th June 2021. Demographic, clinical, laboratory parameters, treatment and outcome were recorded from the medical records and analyzed.

Results: Out of 122 admitted patients,11%, 18.03%, 33.60% and 35.24% presented with mild, moderate, severe and critical illnesses respectively, with the median saturation of peripheral oxygen (SPO₂) at admission was 89(34-99)% and 17 deaths were recorded a mortality rate of 20.4%.A significantly high mortality rate was found among ventilated patients (73.3%), against non ventilated (7.2%). Mortality rates among critically and severely ill patients were 38.46 % and 6.9% respectively. Mean C reactive protein (CRP) was 51.13(±30.50)mg/dl. Statistically significant CRP levels were observed in patients who presented with mild illness (32.53±10.85 mg/dl) and those who died in hospital (61.08±30.00 mg/dl). Remdesivir use did not offer any mortality benefit.

Conclusion: A very high mortality rate (20.40%) observed in this study due to COVID-19 in hospitalized patients, may be associated with a high proportion of severe and critical cases (68.70%) admitted. Further upgrading of health resources should be prioritized to manage severe COVID-19 related mortalities, because of the possibility of a future waves.

Clinical Etiology of Optic Neuropathy patients visiting BPKLCOS, Institute of Medicine, Nepal

2023-08-25T14:49:23+00:00

Background & Objective: The clinical etiology of Optic neuropathy is vast and may be associated with life threatening conditions which might demand initiation of treatment. Therefore, the aim of the study was to evaluate clinical etiology among patients visiting ophthalmology OPD of Institute of medicine, Nepal.

Material and Methods: This is a descriptive study conducted at B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Nepal. All cases of optic neuropathy who presented to outpatient department (OPD), indoor patients from 7^th July 2017-6^th July 2018 were included in the study. A detailed clinical history was obtained which was followed by ophthalmic examination and relevant investigation. In addition, assessment of visual acuity, color vision, contrast sensitivity, visual field were done. Data was analyzed with SPSS version 24.

Results: A total of 86 eyes of 66 patients with optic neuropathy meeting all the inclusion criteria during the study period were enrolled with 20 patients having bilateral eye involvement and 46 having unilateral eye involvement accounting for a total of 86 eyes with optic neuropathy. The mean age of the affected population was 39.12±13.57 years with male to female ratio of 1:1.1. The most common etiology for optic neuropathy was optic neuritis (n=40 patients, 60.6%). Diminution of vision was the most common presenting complaints. Best corrected visual acuity was 6/24 –6/60 in 39.5% cases (n=34). Majority of the eyes had presence of RAPD (n=53 eyes, 61.7%) The most common color vision defect was nonspecific defect (n=41eyes, 47.7%).There was reduced contrast in 55.8% of the affected eyes in cases of optic neuropathy. Majority of affected eyes had blurred disc margin (n=39 eyes, 45.3%) followed by hyperemic disc and pale disc. Majority of the patients could not perform visual field due to low vision but those who could perform had enlarged blind spot.

Conclusion: The most frequent etiological factor for optic neuropathy was optic neuritis. In cases of optic neuropathy, the main complaint of the majority of patients was a dimunition in vision. The majority of cases of optic neuropathy involved abnormalities in both colour vision and contrast sensitivity. The most typical visual field pattern in eyes with optic neuropathy was an enlarged blind spot. Optic neuritis is the most common cause of optic neuropathy, followed by traumatic optic neuropathy, and toxic metabolic optic neuropathy.

Determinants of Birth Asphyxia among Newborn in a Zonal Hospital

2023-08-25T15:09:21+00:00

Background & Objective: Birth asphyxia is a leading cause of brain damage. Early identification and managing of its contributing factor would change the burden of birth asphyxia. Therefore, the objective of this study was to identify the determinants of birth asphyxia among newborn in a zonal hospital, Dhanusha, Nepal.

Material and Methods: A case control study was carried out among 192 newborns where cases and controls were taken in the ratio of 1:1. Newborns with an APGAR score of less than 7 at 1 min and 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. Case includes all asphyxiated newborns at time of data collection. There were total 96 birth asphyxiated newborn and equal number of non-asphyxiated newborn meeting the inclusion criteria were included as a control group. Data was collected by using structured interview schedule and chart review. The data was entered into SPSS version 16. The data were analyzed by frequency, percentage, mean, standard deviation, chi-square test and odd ratio. Those variables with a p-value <0.05 were identified as significant determinants of birth asphyxia.

Results: Findings revealed that rural residency (79.2%), dalit ethnicity (69.6%) and joint family (92.7%) were socio-demographic determinants of birth asphyxia. Finding also revealed that primi-parity (OR:3.2,95%CI:1.7-8.2),problem during pregnancy(OR:3.1,95%CI:1.5-6.6), premature rupture of membrane (OR:23.4, 95%CI: 8.7-62.7), augmentation of labour with oxytocin (OR:12.3, 95%CI:6.1-24.4), sex of newborn (OR:5.0, 95%CI;2.7-9.4), meconium stained amniotic fluid (OR:0.22,95%CI:0.00-0.05), cord round the neck (OR:19.0,95%CI:2.4-24.6) and height of mother (OR:16.2,95% CI:2.0-126.0) were significantly associated with increase odds of birth asphyxia.

Conclusion: Most of the identified determinants were common and familiar causes of birth asphyxia. Early detection can prevent and control birth asphyxia. Thus, every pregnant woman need for better maternal care, so creating awareness about determining factors of birth asphyxia to the midwives, careful monitoring of labour, and identifying and taking proper measures that would help in decreasing the occurrence of birth asphyxia.

Functional outcome of intramedullary nailing of the femoral shaft fracture

2023-08-25T15:26:05+00:00

Background & Objective: A common fracture is a femoral shaft fracture. The advantages of intramedullary interlocking nails make them the method of choice for treating femoral shaft fractures. These benefits include a small incision, minimal dissection, decreased rates of infection, nonunion, and malunion, shorter hospital stays and rehabilitation periods, excellent union, rotational stability and length maintenance, rapid recovery, and early weight-bearing. Therefore, the aim of this study was to analyze the functional findings from femoral shaft fracture intramedullary nailing.

Material and Methods: This was a hospital- based, longitudinal, observational study. All patients with femoral shaft fractures admitted at UCMS-TH, Bhairahawa from the Emergency Department managed surgically from October 2019 to March 2020 were included in the study. Femoral shaft fractures with age ≥ 16 years were included while open fractures (Gustalio and Anderson type 2 and 3), pathological fractures,congenital anomaly of the affected limb, previous fracture of the affected limb were excluded. All the patients were managed surgically and followed for at least 6 months. The outcome was measured by the Thoresen scoring system at the end of 6 months.

Results: In this study of 30 cases, the mean age was 30.47 years, male and female ratio of 2:1, the left side was affected in 18 cases, RTA was the most common mode of injury. Most of the cases were Winquist and Hansen type 2 and AO type 32B. In the majority of the cases, 27 cases (90%) had no complication while superficial infection in 2 cases and shortening was seen in 1 case. We found excellent results in 86.7% cases, good in 10% cases and fair in 3.3% cases.

Conclusion: The excellent functional outcome in terms of alignment and range of motion obtained in this study in the majority of patients makes this technique more reliable. The method of choice for femoral shaft fracture in adults was due to its low complication rate, high incidence of union, shorter hospital stay and early mobility.

Contribution of female community health volunteers on the utilization of ANC and PNC by mothers in two districts of Nepal: a Qualitative study

2023-08-25T15:37:01+00:00

Background and Objectives: A group that has been credited behind the reduction in child and maternal mortality through programs like immunization, integrated management of childhood illnesses, family planning, and preparing pregnant women for delivery are known as Female Community Health Volunteers (FCHV). FCHVs’ roles have gradually expanded beyond family planning programs and especially are focused on maternal and child health services at a large scale. FCHV is often spoken about or spoken for, but there is little evidence of FCHV's own characterization of their practice. so, this study is designed to explores the roles, practices and experiences of FCHVs in the utilisation of Antenatal care (ANC) and Postnatal Care (PNC) services in two contexts; rural and urban Nepal.

Materials and Methods: This is a qualitative study carried out in two districts (one urban and the next rural) viz. Kathmandu and Terathum. Questionnaires leading to in-depth interviews were carried out with 28 FCHVs and 15 service users and Key- Informant Interview with the 8 health facility staff and 15 service users who were purposely selected Data were analyzed using thematic analysis.

Results: The study found out that the FCHVs have been involved rigorously on screening and counseling pregnant women on nutritious foods, counseling family about the birth preparedness, institutional delivery, ANC and PNC services provided at the health facility in rural Nepal. While in urban Nepal, the referrals on ANC existed only in those places which were outside the ringroad. The PNC services were not that used by the mothers in rural Nepal while the PNC referrals were not made by urban FCHVs as the maternity hospital itself called for a follow-up. The motivating factors for FCHVs were self-identity, social responsibility and social recognition and status that kept them in doing voluntary workers over the years.

Conclusion: FCHVs have been contributing a lot of their time and effort to every possible way to make the women of their community survive while being pregnant or after delivery. This study also underlines some of the differences in the real picture of their roles in urban and rural Nepal.

Assessment of Knowledge on impacts of cell phone use among Secondary level students in a selected School of Kathmandu valley, Nepal

2023-08-25T15:49:25+00:00

Background & Objective: All age groups use cell phones as a common form of communication, although adolescents use them especially frequently. Students' daily lives with mobile devices are getting more and more dependent on them, which has led to reliance. Its usage has climbed 67% globally and 44.89% in Nepal. The scale of potential health concerns among mobile phone users has increased due to the rising use of these devices. The objective was to assess how cell phone use affects secondary school students among secondary level school students in a selected school of Kathmandu Valley, Nepal.

Material and Methods: A descriptive cross sectional study was conducted among 100 samples by using Probability Stratified Random Sampling Technique. The pre tested self-administered questionnaire with structured and semi structured questions was used to collect information through online survey by Fluroscent School App from Grade 9 and Grade 10 respondents. The collected data was analyzed by using Statistical Package for Social Science (SPSS) 16 version using descriptive and inferential statistics.

Results: Majority of the respondents (38%) were of age 15 years. The respondents of Grade 9 and Grade 10 were equal. The overall mean knowledge score was 26.870 ± 4.978 regarding the use of mobile. The minimum score obtained is 15 and the maximum score obtained is 37 out of 40 possible correct answers .It showed that 60% of the respondents had average level of knowledge, 32% had adequate level of knowledge and 8% had poor level of knowledge. There was no significant association between knowledge regarding mobile phone use with other selected socio-demographic variables.

Conclusion: The study concluded that there was average level of knowledge regarding impact of cell phone use. Thus, school based cell phone health awareness and education programs are necessity to improve the overall health of students.

Knowledge and Beliefs about Antimicrobial drug resistance and its Implications in Future Prescribers

2023-08-25T16:05:10+00:00

Background & Objective: Antimicrobial drug resistance is the ability of microorganisms to persist or grow in the presence of antimicrobial drugs designed to inhibit or kill them. Since, Bachelor of Medicine and Bachelor of Surgery (MBBS) students will be the future prescribers of antimicrobial drugs, this study aims to observe the existing knowledge and beliefs about antimicrobial drug resistance and its impact on the future use of antimicrobial drugs.

Material and Methods: This cross-sectional study was conducted at Janaki Medical College, Janakpurdham, Nepal, among 223 students of Bachelor of Medicine and Bachelor of Surgery (MBBS) program. Data was collected through a structured and customized self administered questionnaire as a tool from the respondents of MBBS first year to MBBS final Year. Chi square test was applied to test the association between different academic years of MBBS and their knowledge on antimicrobial drugs, antimicrobial drug resistance, beliefs about antimicrobial drugs, and implications of the knowledge of antimicrobial drugs and antimicrobial drug resistance. p<0.05 was considered statistically significant.

Results: Out of the total participants (n=223), the majority participants were male (n=150) and the mean age of study participants was 22.93±2.15 years. There was no statistically significant difference (p>0.05) in the knowledge on antimicrobial drugs among the different academic years of MBBS. However, there was statistically significant difference (p<0.05) between different academic years of MBBS, in most of the responses related to the knowledge on antimicrobial drug resistance and beliefs on antimicrobial drugs. Most of the students from all the academic years agreed that, their current knowledge of antimicrobial drugs and antimicrobial drug resistance was inadequate, and that they would like to have more education on antimicrobial drugs and antimicrobial drug resistance, for their future career as a doctor.

Conclusion: There is a need for more rigorous academic and clinical intervention so that only specific antimicrobial drugs are prescribed with an overall reduction in further development of antimicrobial drug resistance to the existing as well as to the antimicrobial drugs that are still in their clinical trial phases.

Canal of Nuck incarcerated ovarian hernia in a female infant

2023-08-25T16:49:29+00:00

Background & Objective: Hernia of canal of Nuck is a rare condition, and complications like incarceration and strangulation may occur. We present a rare case of incarcerated ovarian hernia within the canal of Nuck diagnosed timely after ultrasound examination.

Presentation of case: A 4-month-old infant girl presented with a left inguinal swelling. On physical examination, there was an oval, non-mobile swelling. Ultrasound examination revealed an incarcerated ovarian hernia with internal doppler flow and immediately sent to surgery department.

Discussion: Canal of Nuck is the persistent inguinal processus vaginalis in female. Failure of obliteration of this canal leads to outpouching of intraperitoneal content into this canal. This persistent canal can contain fluid, omentum, fallopian tube, ovary, uterus and even urinary bladder. Ultrasound examination is handy in examining inguinal canal.

Conclusion: Awareness of Canal of Nuck hernia is important for differential diagnosis and ultrasound examination for correct diagnosis and complication prevention.

A Decade-long Journey of Publishing Janaki Medical College Journal of Medical Sciences (JMCJMS): Experiences from the field

2023-08-25T14:08:33+00:00

N/A