Journal of Patan Academy of Health Sciences

Appropriateness of perioperative antibiotics in thyroid surgery

Deepak Yadav — 2023-05-16

Introduction: Most of the guidelines do not recommend routine antibiotics prophylaxis in clean head and neck surgery like thyroidectomy. In contrary to the recommendation, antibiotics are being routinely prescribed in perioperative period for various duration in many centers of Nepal. This study was aimed to find out the need of postoperative antibiotics in surgeries for thyroid related problems.

Method: Records of all patients who had undergone surgery for thyroid related problems from Jan, 2019 to Sept, 2022 were retrospectively reviewed for patterns of antibiotic use, apart from preincision antibiotic, in postoperative period which was classified as group A – no antibiotics, group B – shorter course of antibiotics (≤3 days) and group C – longer course of antibiotics (>3 days). The occurrence of surgical site infection (SSI) was recorded.

Result: During the study period, 77 patients underwent surgery for thyroid related problems, out of which five were excluded (records not found in four cases and one patient was ASA III). Two out of 72 (2.77 %) patients developed superficial incisional SSI which was managed conservatively. One patient in each group A (50) and group B (8) developed SSI.

Conclusion: Postoperative antibiotics can be avoided safely even in our setup in clean head and neck surgeries like thyroidectomy without increase in the risk of SSI thus reducing the cost to the patients.

Incidence and outcome of transurethral resection of prostate syndrome at a tertiary care hospital

Prabodh Regmi — 2023-05-16

Introduction: Monopolar transurethral resection of prostate (M-TURP) is rarely complicated with the dreaded syndrome the TURP syndrome due to absorption of larger amount of non-electrolyte hypo-osmolar irrigation fluid (1.5% glycine), longer duration of surgery and larger amount of tissue resection. This study aims to find out the incidence and perioperative outcome of TURP syndrome after monopolar TURP.

Method: This was a cross sectional study of retrospectively collected data during the period of 4 years from June 1^st 2018 to 30^th May 2022, in Department of Urology of Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of the incidence of TURP syndrome, its relation with amount of resected tissue, duration of resection time, and the outcome (need of blood transfusion, length of hospital stay, mortality).

Result: Out of 208 cases of monopolar TURP, 8/208(3.8%) had TURP syndrome. Patients with TURP syndrome were age group 70-85 y. Duration of surgery was >60 min was in 5/8(62.5%), resection weight >20 gm 6/8(75%), blood transfusion 1/8(12.5%), and hospital stay >3 days in all 8/8(100%) cases. Mortality was nil in patients with TURP syndrome.

Conclusion: The TURP syndrome was observed in 8/208(3.8%) and it was more common in older (>60y) with longer duration (>60 min) of surgery, and larger amount of prostatic tissue (>20gm) resection.

Diagnostic role of ovarian – adnexal reporting and data system magnetic resonance imaging scoring system for evaluation of indeterminate adnexal lesions

Prabhat Karki — 2023-05-16

Introduction: Magnetic resonance imaging (MRI) plays an important role in distinguishing malignant from benign adnexal mass which are indistinguishable from ultrasonography. This can help in early diagnosis and treatment of indeterminate adnexal lesions. This study aims to evaluate the features suggestive of malignant features and accuracy of ovarian adnexal reporting and data system (O-RADS) MRI score in distinguishing benign from malignant lesions when compared with histopathology which is gold standard.

Method: This was a retrospective study of MRI pelvis carried out in patients with indeterminate adnexal lesions who had MRI pelvis done from 2018 to 2022 at Patan Hospital, Lalitpur, Nepal. Ethical approval was obtained from the institutional review committee of Patan Academy of Health Sciences. MRI diagnosis based on O-RADS MRI score was compared with histopathology diagnosis and sensitivity, specificity was calculated. Chi square test was computed and p-value less than 0.05 was considered statistically significant.

Result: Among 175 patients, 135 had benign and 40 had malignant lesions. Malignancy was common in middle aged patients (41-60years).MRI features of malignancy were multilocular, solid cystic lesion with contrast enhancement, septations and diffusion restriction. Significant statistical association of O-RADS MRI score was found with histopathology diagnosed malignancy. 92.5% of malignancy had O-RADS MRI score of 4 and 5.The sensitivity and specificity of MRI diagnosing indeterminate lesion was 92.5% and 91.85% respectively.

Conclusion: O-RADS MRI scoring is significantly associated with histopathology proven adnexal malignancy hence helps in accurately diagnosing indeterminate adnexal lesions and stratisfying the risk of malignancy.

Accuracy of point of care ultrasound in the diagnosis of long bone fractures in the emergency department

Dipesh Mangal Joshi — 2023-05-16

Introduction: Long bone fractures account for a significant portion of injuries in the emergency department (ED). This study aimed to determine the accuracy of point of care ultrasound (POCUS) compared to x-ray in the diagnosis of long bone fractures in the ED.

Method: This cross-sectional study assessed 147 patients presenting to the ED of Patan Academy of Health Sciences (PAHS), with suspected long bone fractures, from Oct 2021 through Jun 2022. In all patients, POCUS examination was done by emergency fellows and then standard plain x-ray was performed. Data were analyzed by SPSS 28.0 to determine sensitivity and specificity.

Result: A total of 147 patients were included in the study. Compared with x-ray, sensitivity, specificity, PPV and NPV of POCUS in determining fractures was found to be 86%, 98.96%, 97.72% and 93.2%, respectively. Based on bone injured, the highest sensitivity and specificity were obtained with forearm fractures, which was equal to 97.22% and 100%, respectively. Based on age categorization, the highest sensitivity (100%) and specificity (100%) were obtained in pediatric age group i.e. up to 16 years.

Conclusion: This study demonstrated that POCUS has high sensitivity and specificity in the diagnosis of long bone fractures, compared to x-ray.

Knowledge and practice of sunscreen use among medical students at Patan Academy of Health Sciences, Nepal

Madhu Gyawalee — 2023-05-16

Introduction: (259 words) Sunscreen is essential in preventing skin damage caused by harmful ultraviolet radiation. Regular and appropriate sunscreen application delays photoaging and reduces skin cancer risk. This study aims to assess the general knowledge and practice of sunscreen among medical undergraduates in Nepal.

Chronic morbidity and health seeking behavior among post-menopausal women of Itahari Sub-Metropolitan City, Nepal

Pramita Sharma — 2023-05-16

Introduction: The prevalence of morbidity increases in postmenopausal period. Usually co-morbid chronic conditions and symptoms of menopause are underestimated due to low awareness thereby affecting the health seeking behaviour. This study aims to find out the chronic morbidity and health seeking behaviour among post-menopausal women of Itahari sub metropolitan city of Nepal.

Method: This is a community based cross-sectional study conducted in 5 wards of Itahari sub metropolitan city, of Nepal over a period of one year (February 2018 to January 2019) among 490 post-menopausal women of 45 and above age. Ethical approval was obtained. The frequency and percentage of women with chronic morbidity and their health seeking in general was calculated. Also, percentage of health seeking for the each morbidly and postmenopausal symptoms were calculated using MS-Excel.

Result: Among the 490 participants 69.4% were having chronic diseases in which diabetes mellitus and hypertension had highest prevalence. Up to 98% of the women having chronic morbidity sought help from professionals. There was lowest professional health seeking for psychological symptoms and highest for somatic symptoms.

Conclusion: Our study shows high chronic morbidity in post-menopausal period and good health seeking behaviour for them. There is less professional heath seeking for vasomotor and psychological symptoms of post menstrual period.

Study of demography risk factors of simple and complex febrile seizure and associated infection in children at tertiary care center

Dikshya Pant — 2023-05-16

Introduction: Febrile seizures are seizures that occur in children between 6 to 60 months with a temperature of 38°C or higher. It commonly affects male with a peak incidence in below 2 years old. This study aims at identifying the demographic profile of children admitted with the diagnosis of febrile seizure in order to anticipate the condition and counsel the parents.

Method: This is a retrospective cross sectional study conducted in the pediatric ward of Patan Hospital. Medical records of the patients admitted with a diagnosis of febrile seizure (simple or complex) in pediatric ward of Patan Hospital between January 2016 to 2019 were reviewed and data mentioned in the proforma were collected. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences (IRC-PAHS). The data was analyzed using Statistical Packages for Social Sciences Version 25 and frequency and proportion was calculated.

Result: Out of 277 cases fulfilling the study criteria, 70.4% had simple febrile seizure whereas 29.6% had complex febrile seizure. The mean age of the patients was 23.13 months ±12.8 and the median was 19 months (IQR: 14-29). Around 58.12% were males and 41.88% females. Viral fever accounted for the maximum number of infections in around 22.3% (62/277) of patients and viral URTI in 20.21% (56/277).

Conclusion: The study adds to the existing knowledge of febrile seizure in order to help the clinician anticipate febrile seizure.

Assessment of knowledge of diabetes mellitus among female community health volunteers (FCHV) of Jiri, Nepal

Smriti Shrestha — 2023-05-16

Introduction: Type 2 diabetes mellitus (DM) has become a global epidemic with significant disability and premature death. Identification of the level of knowledge related to diabetes among the health workers is important in strategies for prevention of diabetes mellitus.

Method: This study was conducted as a community based study in Jiri Hospital in Dolakha district. All the FCHV working in the Dolakha district were selected for this study. Data was collected using Diabetes Knowledge Questionnaire (DKQ). Data was analysed using SPSS programme version 16.0.

Result: A total of 90 participants were included in the study. Average score obtained was 15 out of 24. There was not significant association found between educational background and score (p-value=0.8835) No significant difference between the age groups and scores was found (p-value=0.5485). No FCHV’s had received training on diabetes mellitus. Having a family member with diabetes did not impact the obtained score (p-value= 0.9511).

Conclusion: This study did not show any relation on knowledge with age, educational background or having a family member with diabetes.

Lithium toxicity: a case report

Ujjawal Paudel — 2023-05-22

Lithium is a commonly used drug for bipolar disorders and requires therapeutic dose monitoring due to its narrow therapeutic index. Acute lithium toxicity frequently occurs due to intentional intake of an excessive amount or due to its interaction with various medicines and medical conditions which alter its absorption or excretion. It may present primarily with neurological and gastrointestinal symptoms. We report a case of lithium toxicity in a patient with bipolar disorder probably due to dehydration and decreased intake of food and fluids. Frequent monitoring of serum lithium level while maintaining hydration and electrolyte balance successfully treated the lithium toxicity.

Workplace violence among nurses of a teaching hospital

Sadhana Paudel — 2023-05-16

Introduction: Workplace violence is a significant issue in the health sector with high prevalence. Workplace violence among nurses is an alarming and fundamental human rights issue with its negative impacts on nurses as well as organizational achievement. This study aimed to explore workplace violence among nurses.

Method: Cross-sectional study design with a total enumerative sampling technique was used to find out the prevalence of workplace violence among 402 nurses of a teaching hospital in Lalitpur, Nepal. Data was collected by using “Workplace Violence in the Health Sector country case studies research Instruments” from September 2019 to November 2019. Collected data were analyzed based on objectives using Statistical Package for Social Science version 16. Descriptive statistics were used to find out the prevalence, types of violence, perpetrators, and socio-demographic information.

Result: The prevalence of workplace violence was 227( among which verbal abuse was 215(94.5%), physical violence 40(17.6%), and sexual harassment 9(4%). Among the perpetrators, 107(40.53%) of workplace violence was done by patients’ relatives, 77(29.16%) by patients, 64(24.24%) by staff, and 16(6.06%) by management.

Conclusion: The prevalence of workplace violence is high. Verbal abuse is the dominant type of violence, followed by physical violence and sexual harassment. The main perpetrators of workplace violence were patients’ relatives. Management was also found to be the perpetrator in a small fraction of violence.

Screening of psychiatric morbidity in a male only prison

Sujana Parajuli — 2023-05-16

Introduction: Psychiatric morbidities such as anxiety and depression are disproportionately higher among prisoners than in general population. Around one in seven prisoners are diagnosed with psychosis or depression. The chronicity of psychiatric morbidities may lead to suicidality among prisoners. Thus, the aim of this study was to screen psychiatric morbidity in a male only prison.

Method: This was cross-sectional analytical study done at Nakkhu Jail in Nepal. A total of 490 prisoners selected by total enumerative sampling were interviewed face-to-face. Modified Mini Screen was used to find out psychiatric morbidities. Data analysis was done using frequency, percentage, mean and standard deviation. Association and correlation between information related to prisoners and environmental variables and psychiatric morbidity were analyzed using Chi-square and Spearman’s rank correlation coefficient test respectively.

Result: The psychiatric morbidity was found positive among 10.41% of prisoners. Suicidality was present among 3.47% of prisoners and 3.06% had post-traumatic stress disorder. There was significant association between length of stay in prison (p=0.026), satisfaction on living facilities (p=0.017), regular health check-up (p<0.001), doctor appointment during health problems (p<0.001) and psychiatric morbidity.

Conclusion: About one tenth of prisoners were found positive for psychiatric morbidity. There was significant association between length of stay, satisfaction on living facilities, regular health check-up, doctor appointment during health problems and psychiatric morbidity. Improving living services, early recognition of psychiatric morbidity through periodic health services and treatment in prison may lead to low prevalence of psychiatric morbidity.

Challenges of evidence based medicine in clinical practice

Nabees Man Singh Pradhan — 2023-05-16

Evidence-based medicine (EBM) is an approach by clinicians that involves conscientious, explicit, and judicious use of available evidence in deciding on the care of individual patients.¹ With the digital revolution and easy access to the available literature, EBM , which was not very practical a few decades ago due to the difficulty in assessing the resources, has been practiced with increasing success nowadays, even in the developing world. The revolution brought about by EBM with regard to the practice of medicine over the past few decades has been remarkable.² Because of the individualized treatment based on external evidence, EBM leans towards justifying the action with accountability; hence being labeled as the fourth revolution in American Medicine.³