Janaki Medical College Journal of Medical Science

Nepal can be hub for Medical/Paramedical students of the world: A big business to contribute in Nepalese Economy

Kshitiz Upadhyay Dhungel — Sun, 28 Aug 2022 00:00:00 +0000

Editorial

Access to health services and health inequalities in remote and rural areas

Sun, 28 Aug 2022 00:00:00 +0000

ABSTRACT

Access to health care includes the availability, accessibility, awareness, accommodation or adequacy, affordability, and acceptability of health services. Scarce health facilities, long distances to health facilities, shortages of medicine, level of poverty, shortages of doctors, dentists, and other health professionals, level of education and knowledge among populace on orthodox treatment practices are factors that affects access to health care. Level of awareness among the populace of preventive and curative services offered by health facilities, absence of health insurance, and inability to afford the cost of health services are obstacles limiting rural people from recognizing and achieving the health and social related Sustainable Development Goals (SDGs), that requires that access to good quality healthcare is improved significantly in rural areas and under-served population.

Health inequalities exist both between and within developed and developing countries, both between and within urban, semi-urban and rural areas. Health inequalities are determined by various socioeconomic factors: such as age, sex, race, ethnicity, education, income, social status, unemployment and place of residence of the population. The factors that give rise to, and worsen, inequalities in health are multidimensional. Interventions in addressing health inequalities would involve economic policies, strategic health planning, health education on avoidable risk factors for poor health, use of telemedicine/tele dentistry, and reduction of unmet healthcare needs among various population groups. Other interventions are poverty eradication interventions especially in remote and rural areas, healthcare financing through budgetary allocation, and improving access to health service through universal health coverage, with an organized and efficient health system.

Spirometric Evaluation of Effect of Air Pollution on Pulmonary Functions of Traffic Police in Kathmandu Valley

Om Prakash Yadav, Matiram Pun, Narayan Bahadur Mahotra, Binaya S.J.B. Rana — Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: Traffic police personnel are exposed to ambient air pollution which leads to important health hazards like impairment of lung functions. The objectives of this study were to measure and compare the pulmonary function parameters of traffic police and general duty police and also aimed to evaluate the effect of job duration on those parameters in Kathmandu valley.

Materials and methods: A cross-sectional comparative study was done in a total of 133 healthy, non-smoker, male policemen working in Kathmandu valley for a minimum of one year. Out of them, 70 were from traffic police and 63 were from general duty police. MIR Spirolab II was used for pulmonary function test (PFT) measurement. Statistical analysis was done using SPSS version 20. The results were presented as mean ±SD and Independent sample t-test: was used. The p-value <0.05 was considered statistically significant. Pulmonary functions of the two groups were compared.

Results: There was a statistically significant decrease in FEV₁, FEV₁/FVC and FEF_25%=75%among policemen working in Kathmandu valley for seven years or more as compared to those working for less than seven years. Although the traffic police had lower FVC, FEV₁, FEV₁/FVC and PEF in comparison to the general duty police, these differences were not statistically significant.

Conclusion: The findings of this study demonstrated that pulmonary functions of both the traffic and the general duty police decrease with increase in duration of job in Kathmandu valley. The pulmonary functions of the traffic police were lower than their predicted values although they were not significantly lower than those of the general duty police.

Keywords: Lung function, Spirometry, Traffic policemen, FVC, FEV₁, PEF, FEF_25%-75%

Correlation of Biochemical Parameters among Diabetes patients attending Medicine OPD of Janaki Medical College Teaching Hospital

Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: With increasing incidence of diabetes mellitus, the cardiovascular and renal complications associated with it are emerging as major concern. The morbidity and mortality associated with diabetes can be reduced by timely assessment of those risk factors. Our study evaluated lipid profile and renal function test in male and female diabetic patients as well as the correlation among those biochemical parameters.

Materials and methods: Blood sugar, lipid profile and renal function test were assessed in 249 confirmed type 2 diabetic patients attending medicine OPD of Janaki medical college teaching hospital (JMCTH), Ramdaiya-Bhawadi, Dhanusha, Nepal. Independent ‘t’ test was used to observe the gender difference in those parameters and Pierson correlation test was applied to look for correlation among different biochemical parameters.

Results: Significant difference was observed between male and female for FBS (p=0.05) and PPBS (p=0.003). Such significant difference between male and female was also noted for lipid profile parameters, TC (177.65+43.09 and 163.45+35.68 respectively, p=0.05), VLDL-C (33.47+16.51 and 28.83+14.00 respectively, p=0.018) and HDL-C (40.52+10.62 and 37.94+8.07 respectively, p=0.033). According to our study TC, TG, VLDL, LDL, HDL showed significant positive correlation with FBS and PPBS. Likewise, creatinine, urea, uric acid was also positively correlated with FBS and PPBS (p<0.05). Moreover, there was significantly high correlation of uric acid with TC, TG, VLDL, LDL (p<0.05). In addition, there was highly significant correlation between creatinine and sodium.

Conclusion: There was a significant difference for blood sugar and lipid profile among male and female diabetic patients. Correlation was seen between blood sugar and lipid profile; uric acid and lipid profile as well as creatinine and sodium.

Study of the Variations of Asterion, Pterion & Inion in Human Dry Skulls & its Anthropological importance

Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: Asterion is the meeting point of three bones namely parietal, temporal and occipital bones in the norma lateralis of all human skulls the variations showed a pattern of formations. Pterion is the point of convergence of the sutures between the frontal, sphenoid, parietal and squamous temporal bones. Asterion have profound surgical importance.

Materials and methods: Good intact skulls from different medical college of Nepal were used for the present study. Each skull was studied in detail regarding the formation of Asterion, Pterion on both sides and associated findings were observed. Sixty eight dry unknown human skulls constituted the materials for the present study. The observation was made on Asterion, Pterion & Inion. This study was done in the departments of Anatomy in different medical colleges of Nepal between the years 2019-2021.

Results: Incidence of asterion with wormian bones on the right side was 4.41% that of the left side 5.88%. More number of H shaped pterion on the right side [80.82%} than on left side [70.94%). Presence of Wormian bones more on the right side [7.69%] than on the left side [2.94%) were observed.

Conclusion: The knowledge of the formation of asterion and the presence of wormian bones in the sutures at the site and its effect should be known not only to the Anatomists but also to the Radiologist and the Neurosurgeons because it has profound neurosurgical importance. Hence this study has been done and reported.

Perception of Students and Teachers on Practice of Logbook Maintenance and its Value in Pre-Clinical Years

Namrata Upadhayay, Sanjeev Guragain — Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: Logbook keeps the record of practical work done by the students throughout a year. This study was carried out to know the perception of students and teachers on the logbook maintenance and its importance during the practical examination in pre-clinical science.

Materials and methods: A cross-sectional descriptive study was done in pre-clinical science teachers (n-9) and students (n-40). A semi-structured questionnaire was used to find the (i) Knowledge and importance of logbook (ii) logbook correction and feedback (iii) logbook improvement and examination. Close ended questions data are expressed in percentage. Open-ended responses were categorized, classified according to the theme-wise and later expressed in percentage.

Results: Most of the students (70%) and teachers (100%) listed creditable advantages of maintaining the logbook. They quantified logbook: as notes for the examination, development of dedication and habit of task completion, boost knowledge and skills, development of sense for self-evaluation, problem solver and motivates them to learn and save their time, guide for quick and precise knowledge during revision, and correct tool to practice skills. However, all teachers and 45% of students mentioned that they lack proper maintenance of logbook on regular basis. The major flaws behind it were copying from seniors/colleagues, writing without feedback and consultation with teachers or books. The other reason for students’ negligence to fill the logbook is due to less quantification of marks for the logbook at the time of examination. Students suggested in updating data, paper quality and pictures of the logbook. Teachers and students emphasized to include marks in each practical class.

Conclusion: Students are lagging behind on proper maintenance of the logbook. To ensure that students have used the right techniques while practicing skills need to be monitored and guided on time. This monitoring to some extent can be assured by getting through the logbook and giving prompt feedback to them on the desk. The training on the logbook maintenance and marks allocation on each practical might enhance the perseverance learning in the students.

Histopathological study of malignant lesion of Cervix in a tertiary care hospital of Nepal

Krishna Kumar Jha, Ritu Baral — Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: Like in other developing countries, cancer of cervix is one of the leading malignancies in women in Nepal. In Nepal cervical pap-smear screening is not done my most of due to lack of awareness. The objective of this study is to find the prevalence of abnormal cervical epithelial lesions.

Materials and methods: This was a retrospective study of 140 hysterectomy specimen reported from the Department of Pathology, Birat Medical College in Biratnagar. All tissue blocks of cervical tissues were retrieved, stained by Haematoxyline and Eosin (H & E) stain and re-examined. All the case was reviewed by consultant pathologist of Birat medical college.

Results: In the present study out of 140 cases 08 ie. 5.71% have cervical epithelial neoplasia I. 1.42% cases is of CINII, 0.71 is of CINIII and 2.85% is squamous cell carcinoma.

Conclusion: This study has demonstrated that 10.69% of the examined cases were abnormal. The squamous cell carcinoma is leading cancer in our study ie. 2.85%. In developing countries if patient is detected with abnormal pap smears then hysterectomy is indicated.

Evaluation of Pneumatic Vs Holmium: YAG Laser Lithotripsy in the Treatment of Ureteric Stone

Sun, 28 Aug 2022 00:00:00 +0000

ABSTRACT

Background and objectives: Among many lithotripters for fragmentation of ureteric stones, pneumatic and Holmium: YAG laser lithotripsy has reported favorable outcomes. The aim of this study is to compare the efficacy of pneumatic lithotripsy with laser lithotripsy in ureteral stone.

Materials and methods: In this prospective study, 60 patients with diagnosis of ureteral calculus underwent ureteroscopic lithotripsy in Urology Unit, Department Surgery, National Medical College and Teaching Hospital over period of 2020 to 2021. They were divided randomly into two groups, each group with 30 patients.

Group PL was treated with Pneumatic lithotripsy and Group LL was treated with Holmium: YAG laser lithotripsy. History and detailed clinical examination was performed as per the working proforma which included. Result of both the procedures was assessed. Chi square test were used for correlation analysis. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.

Results: Mean age was 26.5 years and 36.33 years in group PL and LL respectively (P=0.58), there was no significant difference in male to female ratio and mean stone in both groups. Duration of operation was significantly lower in LL group and Hospital was slight lower in LL group as compare to PL group (0.95).

Conclusion: Ho:YAG laser and pneumatic lithotripsy are efficient and safe procedures for ureteral stones. Though operative time is higher in pneumatic lithotripsy.

Outburst of Food Poisoning among Hostellers of Certificate Level Nursing Students at Janaki Medical College, Dhanusha

Hari Narayan Purbey — Sun, 28 Aug 2022 00:00:00 +0000

Background & Objective: Food poisoning is the result of eating contaminated, spoiled or toxic food and frequently felt in our society. There are more than 250 food borne diseases. Some of them causes complications even to death. It is worldwide public health burden as well. Causative agents werebacterial, protozoal, possible chemicals and some confounders. This study aims to evaluate the causative agents and treat the patients with protocol in Emergency.

Material and Methods: A purposive descriptive observational study of food poisoning in Proficiency Certificate level Nursing students in Janaki Medical College was done. All students and staffs were under survey by admitting in the Emergency ward and maintaining the treatment in observational ward. Proper history taking, Physical examination and investigations were done. Knowledge, Attitude and Practices of causation, safety risk, control measure and prevention of food handling were sensed by valid questionnaires. Data were analyzed using SPSS version 20.0.

Results: All patients (n=51) were female of 20 districts. 92% cases were of emerging adults. BMR ranges 17.5-25. 83% cases were admitted in observational ward and 5.4% cases were self-limited. Clinical features were abdominal pain (70%), diarrhea (70%), fever with chills (70%), headache (52%), Nausea (35%) and vomiting (31%). Hemogram showed 52% cases were of leukocytosis. Neutrophilia (88%), lymphocytosis (52%), anaemia (46%), hypoglycemia(72%), hyponatraemia (16%) and hypernatraemia (6%).Stool RE/ME showed loose stool(100%), green(100%) in colour, mucoid (10%) consistency in physical examination while plenty of pus cell (100%), undigested food particle (40%), microscopic RBCs(20%), Entamoeba histolytica (10%) were seen in microscopic examination. Stool culture showed 80% cases were of pathogenic E.coli. and 10% cases were of shigella. Three cases were urine culture isolates with E. coli. Overall, questionnires to Knowledge, Attitude and Practices of food handling, safety and risk about food poisonings were found satisfactory.

Conclusion: The causative agents were EPEC (clinically), shigella dysentery and E. histolytica. The sensitivity patterns of antibiotics were of ceftriaxone, ciprofloxacine, meropenum, chloramphenicol, clindamycin, Piperacillin with Tazobactam. Overall assessment of Knowledge, Attitude and Practices about food handling, safety and risk factors were found satisfactory. The responsible departments were emphasized to take appropriate actions in specific way for further control and prevention of food poisoning.

Knowledge regarding health hazards on cell phone use among higher secondary level students in a metropolitan city of Nepal

Shova Dawadi, Tanuja Kumari Chaudhary, Mala Rijhal — Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: Due to wide spread use of the Global System for Mobile Communications (GSM) mobile phones they have become indispensable as communication tools and any consequent in biological effects should be important as a high-priority environmental health issue. Their use without any knowledge of their harmful effects is unsafe. The objectives of this study was to findout Knowledge regarding health hazards on cell phone use among Higher Secondary Level Students, Birgunj.

Materials and methods: A descriptive cross sectional research design was used. Sample size was 111 higher secondary level students. Non-probability sampling techniques was used to selected College and class XI and XII. Whereas, 750 students were class XI with 8 section and class run in morning and day shift. Similarly, class XII had 700 students with 6 section and class run in morning and day shift. Out of 1450 students, 61 students from grade XI and 50 students from grade XII, altogether 111 students were selected respectively by using Stratified Sampling technique from proportionate method. Self- Administered Questionnaire was used for data collection. Data entry and analysis was done in SPSS version 17. Data was analyzed by using descriptive (frequency, percentage, mean) and inferential statistics (chi square test) to identify association between level of knowledge with selected variables.

Results: The finding of the study showed that all most (89.2%) respondents had poor level of knowledge and only 12 (10.8%) respondents had average level of knowledge. Almost all (98.2%) respondents had cell phone among them 78 (71.6%) have smart phone. In the inferential statistics there were statistically significant association (p<0.05) between level of knowledge and grade (0.003).

Conclusion: This study concluded that knowledge regarding health hazards on cell phone use is poor among higher secondary level students. Some educational intervention need to organized on this topic by giving different programs on television, radio, newspaper, and internet to discourage unhealthy practice of cell phone.

Clinical Profile of Acute Pancreatitis

Aditya Prakash Yadav, Akash Raya, Binod Kumar Rai, Rabin Pratap Shah — Sun, 28 Aug 2022 00:00:00 +0000

Background and objectives: Acute pancreatitis is a disorder that has a wide-ranging presentation, etiology, multifactorial pathogenesisandclinicalconsequencesfrommildselflimitingtoseverelife threatening. The aim of this study is to evaluate demographic characteristics, etiology, clinical presentation and its management.

Materials and methods: This retrospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of45 patients with diagnosis as acute pancreatitis over period of March 2020 to February 2022 were included in this study. History and detailed clinical examination was performed as per the working proforma which included. Chi square test were used for correlation analysis. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.

Results: Most of acute pancreatitis were seen in 20-39 years of age group with mean age of 39.7 years. 66.6% patients were female. Gall stone was the most common cause (71.1% patients) of pancreatitis. Abdominal pain was the most common mode of presentation, and tenderness the most common sign. Most of the patients were managed conservatively. Median hospital stay was 9 days.

Conclusion: Acute pancreatitis is a common cause of acute abdomen in patients presenting to the emergency department. Gall stone is the most common cause of acute pancreatitis .Clinical diagnosis along with biochemical and radiological findings are required for diagnosis .The management is mainly conservative.