Journal of Nobel Medical College 2019-07-03T19:34:35+00:00 Dr. Ram Hari Ghimire Open Journal Systems <p>Published by the Research and Publication Unit of Nobel Medical College, Biratnagar. Full text articles available. JoNMC is also available on its own <a href="" target="_blank" rel="noopener">website</a>.</p> <p>The journal is now accepting online submissions. For information on the process <a title="Author Info" href="/index.php/JoNMC/information/authors" target="_self">click here</a>.</p> <p>On 11th November 2019, JoNMC was accepted onto <a href="" target="_blank" rel="noopener">DOAJ</a>.</p> Marching Towards Achieving Quality Research Papers for Medical Journals 2019-07-03T19:34:19+00:00 Arambam Giridhari Singh <p>Not available.</p> 2019-06-14T00:00:00+00:00 ##submission.copyrightStatement## Clinical Profiles and Endoscopic Findings of Patients Undergoing Colonoscopy in Nobel Medical College 2019-07-03T19:34:19+00:00 Rishab Shrestha Alisha Rajbhandari Gaurav Chhetri Rejina Shahi Regmi Pradip Chaudhary <p><strong>Background:&nbsp;</strong>Colonoscopy is an invasive procedure used both diagnostically and therapeutically. Direct visualization and real-time image of entire large colon and distal terminal ileum makes it superior. Patients are unable to undergo colonoscopy because of the limitation in the developing country. Moreover, limited studies are available in our country regarding the colonic diseases.</p> <p><strong>Materials and Methods:&nbsp;</strong>It was a descriptive cross-sectional study done in Nobel Medical College Teaching Hospital, Biratnagar, Nepal from January 2018 to December 2018. Approval was acquired from Institutional Review Committee. All patients undergoing colonoscopy in the hospital was included. After taking proper consent, bowel preparation, premedications, colonoscopy was performed, findings noted in pro-forma.</p> <p><strong>Results:&nbsp;</strong>Of the total 176 patients 119 (67.60%) were male and 57 (32.40%) were female; mean age 46.98 ± 17.13 years. Indication for performing colonoscopy was chronic diarrhea in 58(33.0%), chronic abdominal pain in 47(26.70%). Significant lesion observed in 142 patients (80.68%); colitis with unspecified etiology in 69 (39.20%), ulcerative colitis in 28 (15.90%), crohn’s disease in 13(7.38%).Colitis was more in male 46(66.67%) and involving rectum was common. Pan-ulcerative colitis was common seen in 11patients (39.28%).</p> <p><strong>Conclusion:&nbsp;</strong>Chronic diarrhoea and chronic abdominal pain were two common indications. Male patients were in higher prevalence opting for colonoscopy. Colitis of unspecified etiology of rectum and ileo-cecal region was most common finding. Ulcerative colitis involving whole of colon and younger age group was predominantly affected.</p> 2019-06-14T00:00:00+00:00 ##submission.copyrightStatement## Radiographic Study of Mental Foramen in Nepalese Population 2019-07-03T19:34:22+00:00 Pragya Shrestha Sneha Maskey Dil Islam Mansur Manoj Humagain <p><strong>Background: </strong>Mental foramen is the opening on the anterolateral surface of mandible that marks thetermination of mandibular canal through which mental neurovascular bundle exit. This studyis aimed at determining the location of mental foramen among Nepalese population.</p> <p><strong>Material and Methods: </strong>A retrospective study was performed in panoramic radiographs (orthopantomograms) of the patients collected from Department of Oral Medicine and Radiology, Dhulikhel Hospital. Planmeca Promax machine was used to take the radiographs of the patient and Planmeca Roxemis software was used to analyze the digital radiographs. The horizontal position and vertical distance of the mental foramen was evaluated.</p> <p><strong>Results: </strong>The study revealed that the most common position of the mental foramen was between first and second premolar (bicuspid) 186 (54.7%) and the second common position was in line with second premolar 122 (35.9%). The mean distance between mental foramen and in fervor border of mandible of male was 12.31 1.64 and female was 10.83 1.19. Independent sample t-test analysis showed a highly significant difference in the distance between mental foramen and inferior border of mandible among male and female (P=0.00).</p> <p><strong>Conclusion: </strong>The most common location of mental foramen was between first and second premolar; however, the study revealed the anatomical variation in the positions. So, proper investigation of mental foramen is indispensable before treatment planning to prevent iatrogenic damage to neurovascular bundle.</p> 2019-06-14T00:00:00+00:00 ##submission.copyrightStatement## Relation of fovea palatine and vibrating line in different soft palatal forms 2019-07-03T19:34:23+00:00 Shanti Chhetri Ankita Rathi Neha Gupta <p><strong>Background:</strong> The posterior palatal seal (PPS) area plays a major role in retention of a maxillary denture. Many dentures have failed due to faulty recording of posterior palatal seal area. Hence, locating posterior palatal seal area is a critical step in complete denture fabrication. Various techniques have been described in the literature for locating the posterior border of maxillary complete denture. One of the most commonly used methods is the one that uses anatomical landmark like fovea palatine for locating the palatal seal area. However, many studies show a wide range of variation regarding position of fovea palatine with the vibrating line.</p> <p><strong>Materials and Methods: </strong>A total of 200 subjects were selected for the study and clinical examination carried out to mark the vibrating line and fovea palatine. The location of vibrating line whether it is anterior to fovea palatine, on the fovea palatine or posterior to the fovea palatine in the different soft palate type(Class I, II or III) was recorded using the phonation method.</p> <p><strong>Results: </strong>The vibrating line was located interiorly to the fovea palatine in 70%, 54% and 60% of the subjects with Class I, II and III soft palate. The vibrating line was located on the fovea palatine in22%, 40% and 36% of the subjects with Class I, II and III soft palate and posteriorly to the fovea palatine in 23%, 5% and 3% of the subjects with Class I, II and III soft palate respectively.</p> <p><strong>Conclusion: </strong>The vibrating line was predominantly found to be anterior to the fovea palatine in all the soft palatal forms.</p> 2019-06-14T00:00:00+00:00 ##submission.copyrightStatement## Spinal cord injury, Clinical Profile and its Management at Tertiary Care Center in Nepal 2019-07-03T19:34:24+00:00 Prakash Kafle Babita Khanal Dipak Kumar Yadav Deepak Poudel Iype Cherian <p><strong>Background: </strong>Spinal cord injury causes serious disability among patients. More than 40 million people worldwide suffer from Spinal cord injury every year. Most of them are young men. More than10% of trauma victims sustain spine injury and have higher mortality than other injuries.</p> <p><strong>Materials and Methods: </strong>This is a prospective observational hospital based study of traumatic spine injury cases admitted at Nobel Medical College Teaching Hospital, Biratanagr, Nepal from November 2017 to October2018.</p> <p><strong>Results: </strong>Total of 352 cases were observed and 36 cases who meet the inclusion criteria for surgical intervention were analyzed. Most common affected age group was between 31-40 years with mean age of 40 years. Out of total cases, 81% were male. Most common cause for spine injury was road traffic accident. Cervical spine was the most common injury (66.7%) and C5- C6subluxation being common radiological diagnosis. ASIA-C neurology status (41.7%) on presentation being most common neurological status. Head injury was the most common associated injury. Anterior cervical discectomy and fusion was the most common surgical procedure performed. Superficial surgical site infections were observed in two cases and hardware failure was seen in one case.</p> <p><strong>Conclusion: </strong>The epidemiology of traumatic spine injuries in eastern region of Nepal is similar with other developing countries. In present study, most common cause of spine injury was motor vehicle accidents followed by fall injuries and seen in male. Prevention of road traffic accident might decrease the incidence of spine injury there by reducing the national burden.</p> 2019-06-14T00:00:00+00:00 ##submission.copyrightStatement## Study of Patients with First unprovoked Seizure in the Eastern Part of Nepal 2019-07-03T19:34:25+00:00 Dilli Ram Kafle Surendra Sah Miluna Bhusal <p><strong>Background:</strong> About 5-10% of the population get at least one seizure in their lifetime. Treatment is started in patients with first unprovoked seizure if the risk of seizure recurrence is predicted to be high. If patients with first seizure are not treated 40-50% of patients develop recurrence within 2 years of the initial seizure. Starting treatment may cause reduction in the risk of recurrence by almost one half. The aim of the study was to identify the factors causing recurrence in patients with first unprovoked seizure.</p> <p><strong>Materials and Methods: </strong>It is a prospective cross-sectional study conducted at Nobel Medical College from March 2015 to March 2019. Patients who presented to Nobel Medical College with first unprovoked seizure were enrolled in the study with follow up during the hospital visit.</p> <p><strong>Results: </strong>Eighty six patients participated in our study. Recurrence of seizure occurred in 21(24.4%) patients within the study period of 4 years. Abnormal Electroencephalography was significantly associated with recurrence of seizure in patients with first seizure. (P value&lt;0.001) Neuro imaging abnormality was also associated with increased risk of seizure recurrence (Pvalue&lt;0.001) .Starting an antiepileptic after first seizure reduced the risk of further seizure.</p> <p><strong>Conclusion: </strong>Recurrence of seizure was observed in almost a quarter of patients within the study period of four years. Recurrence risk was higher in those patients with abnormal Electro encephalography and in those patients with identified cause than those patients whose seizure was assumed to be idiopathic.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Comparison of Efficacy of Nebulisation with Salbutamol versus Adrenaline in Acute Bronchiolitis in Children aged Two Months to Two Years 2019-07-03T19:34:26+00:00 Vijay Kumar Sah Arun Giri Sanjay Sah Niraj Niraula <p><strong>Background: </strong>Bronchiolitis is an acute, highly communicable lower respiratory tract infection. A variety of agents ranging from nebulised racemic epinephrine, salbutamol and routinely available levoepinephrine have been tried. The Present study was aimed at comparing the effectiveness of adrenaline and salbutamol in acute bronchiolitis in children aged 2 months to 2 years.</p> <p><strong>Materials and Methods: </strong>The Present study was conducted at Nobel medical College Teaching Hospital over the period of one year from Feb 2018 to Jan 2019. Two different cohorts were identified in which clinically diagnosed cases and were grouped into Group A and Group B to receive the different drugs as per the study protocol. Respiratory Distress Assessment Instrument (RDAI) Scores was used for clinical assessment.</p> <p><strong>Results: </strong>The age of the patients ranged from 2 months to 24 months with a median of 8 months. The males constituting about 57.42% of the study population of 155 patients. On comparing the prenebulisation variables with 10 and 30 minutes post nebulisation values, it was found that Both adrenaline and salbutamol caused overall significant improvement in RR (p-value &lt;0.00001 in both groups) except in the age group of 19-24 months. Adrenaline was seen to be superior to salbutamol in decreasing the RR (p&lt;0.0001) except for children in the age group of 19-24months. Adrenaline also caused greater rise in heart rate in comparison to salbutamol in all age groups.</p> <p><strong>Conclusion: </strong>This study concludes that Adrenaline was seen to be superior to salbutamol in decreasing the RR and RDAI, although it showed variance with age.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Cholinesterase and Liver Enzymes in Patients with Organophosphate Poisoning 2019-07-03T19:34:27+00:00 Prabodh Risal Sandip Lama Saroj Thapa Rajendra Bhatta Raj Kumar Karki <p><strong>Background: </strong>Organ phosphorus compounds are one of the most common causes of insecticide poisoning worldwide leading to high degree of morbidity and mortality especially in the developing countries like Nepal. The liver is the main organ that metabolizes various compounds including toxins, chemicals and drugs and eventually excretes from the body. Few studies have been done in Nepal to see the level of liver enzymes among the organ phosphorus compounds poisoning. This may helps in early diagnosis of acute hepatic failure and reduces OP poisoning related death.</p> <p><strong>Materials and Methods: </strong>Retrospective chart review study was done with organophosphate poisoning attending Emergency Department followed by admission to Medicine ward or ICU of Dhulikhel Hospital from April 2014 to September 2017. And, laboratory data was extracted from laboratory software, MIDAS version 3.2. After collection of data, statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 21 software.</p> <p><strong>Results: </strong>Majority of the patients with organophosphate poisoning were female with 64.8% and the majority (31.5%) of patient were of age group in the age group 16-25. Plasma cholinesterase level was found to be significantly decreased in the patients with organophosphate poisoning. Random blood sugar was significantly found to be raised in this study (125.77±52.3), p-value0.04. Among all liver enzymes, there is a significant negative correlation of Cholinesterase with AST (r = -0.35; p-value&lt;0.05).</p> <p><strong>Conclusion: </strong>This study showed that the level of liver enzyme do not correlate well in the cases of organophosphate poisoning except of AST, which has been raised significantly.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Endoscopic Septoplasty without Nasal Packing: An Experience in a Tertiary Hospital 2019-07-03T19:34:29+00:00 Meenakshi Basnet Bedajit Rajkumar Bibek Ghimire Akriti Shrestha <p><strong>Background: </strong>Deviated nasal septum (DNS) is easily caused by trauma and septal surgeries have evolved from forceful fractures to endoscopic surgery being the leading trend now. Endoscopic surgery has lots of advantage over the conventional headlight method in alleviating symptoms and reducing complications. Endoscopic septoplasty without the nasal packing significantly shorten the surgery time and hospital stay thus reducing the financial burden. Hence this prospective study done in Nobel Hospital and Teaching Center was an Endeavour to see the indications, technique and outcome of the new surgical procedure.</p> <p><strong>Materials and Methods: </strong>Sixty-five patients irrespective of sex in the age group of 18-60 years were enrolled in the study from December 2017 to December 2018. All symptomatic DNS confirmed by 00 and 300 rigid endoscope were enrolled. Informed consent from patients and ethical clearance was taken.</p> <p><strong>Results: </strong>The maximum patients were in the age group of 18-30 years. The commonest symptoms of the patient was nasal obstruction in 51(78.46%), followed by post-nasal drip in 20(30.76%), hyposmia in 17(26.15%), headache in 15(23.07%) and epitasis in 10(15.38%). According to Mladina classification, the commonest deviated septum was type V in 29(45%), followed by type VI in12(18%), type II and IV in 7(11%) each, type VII in 6(9%) and least being type III in 4(6%) patients. There were no patients with Mladina type I DNS in this study. The improvement in symptoms were 90% in nasal obstruction, 88% in hyposmia, 85% in post nasal drip, 90% inepistaxis and 100% in headache. The complications were haemorrhage in 1(1.5%), synechia2(3.07%), mucosal tear 5(7.69%), haematoma 1(1.5%) and persistant DNS 5(7.69%). The average hospital stay was 48 hours.</p> <p><strong>Conclusion: </strong>Endoscopic septoplasty without post-operative packing is very convenient to the patient. Endoscopic septoplasty with trans- septal suture is safe, cost effective and a better alternative.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Echocardiographic Study of Congenital Heart Disease in Infants of Diabetic Mother 2019-07-03T19:34:30+00:00 Babita Khanal Manoj Kumar Shrivastava Prakash Kafle Pushpa Kumari Shah <p><strong>Background: </strong>Maternal diabetes mellitus (DM) has been shown to be high risk factor for congenital anomalies. It carries 3-5 times higher risk of incidence compared to the general population. The aims of present study is to investigate and portray the incidence of congenital heart disease in infants of diabetic mothers and know the utility of echocardiography in the early diagnosis of CHD at Nobel Medical College teaching hospital, a tertiary care centre in the eastern part of Nepal and review the current literature.</p> <p><strong>Material &amp; Methods</strong>: This is a prospective observational study conducted in Nobel Medical College Teaching hospital, Kanchanbari, Biratnagar Nepal over the period of 12 months. A structured questionnaire was designed which included demographic profile and the Echocardiography findings. The collected data were analysed using window’s SPSS version 20.</p> <p><strong>Results: </strong>In the present study of the total deliveries 1.99 % was diabetic mother comprising 208 deliveries.127 had undergone echocardiography in which 10.2 % (n=13) had anomalies. One hundred sixteen were term and 11 were preterm. PDA was the most common anomaly (38.4%) followed by VSD (23.1%) and HCM (15.4%).</p> <p><strong>Conclusion: </strong>With the review of current literature it has been found that maternal diabetes mellitus is a significant risk factor for congenital heart disease so it is suggested that the presence of diabetes mellitus in a pregnancy should be taken as a strong suspicious of having CHD and infants should be screened for the same .so as to diagnose the anomaly at the earliest possible.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Clinical Profile of Patients with Heart Failure in Eastern Part of Nepal: a Hospital based study 2019-07-03T19:34:31+00:00 Abdul Khaliq Monib Sahadeb Prasad Dhungana Rajesh Nepal Rinku Ghimire <p><strong>Background: </strong>There is limited information on the clinical profile of patients with heart failure from the Nepalese population.</p> <p><strong>Materials and Methods: </strong>This is a descriptive cross-sectional study on 120 consecutive patients with New York Heart Association class II or IV symptoms of heart failure admitted from June 2018 to January 2019 at Nobel Medical College Teaching hospital, Biratnagar, Nepal.</p> <p><strong>Results: </strong>Mean age was 52.2 ± 20.6 years. The male and female ratio was 0.71. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, acute coronary syndrome, hypertensive heart disease, and peripartum cardiomyopathy were common etiologies constituting 22.5%, 19.1%,13.3%, 9.1%, 8.3 %, 5% of cases respectively. Among co-morbid conditions, anemia (91.6%),hypertension (31.6%), coronary artery disease (29.1%), diabetes (20.8%) and chronic kidney disease (11.6%) were common. Among various drugs used, 66.6% patients were prescribed diuretics, 60% mineral corticoid receptor blockers, 33.3% angiotensin-converting enzymeinhibitors, 33.3% beta-blockers, 29.1% digoxin and 8.3% angiotensin receptor blockers. Echocardiography revealed LV systolic and diastolic dysfunction in 75% and 25% respectively, mitral regurgitation in 52.5%, right ventricular dysfunction in 10.8 % and pulmonary artery hypertension in 66.6%.</p> <p><strong>Conclusion: </strong>Appropriate use of evidence-based therapies, careful attention to the diagnosis and management of specific co-morbidities in patients with HF may help to improve outcomes.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Evaluation of Crofton, Horne, Miller Scoring as Diagnostic Tool for Tuberculosis in Children 2019-07-03T19:34:32+00:00 Arun Giri Vijay Kumar Sah Sunil Kumar Yadav Niraj Niraula <p><strong>Background: </strong>Tuberculosis which is caused by Mycobacterium tuberculosis a chronic infectious disease is considered the second most common infectious cause of mortality and morbidity in children around the world. This study was carried out to test the validity of Crofton, Horne and Miller scoring system for the diagnosis of children suffering from tuberculosis.</p> <p><strong>Materials and Methods: </strong>It was done in an inpatient ward of a pediatric tertiary referral centre, from Feb 2018 to Jan 2019as a prospective case control study, including 92 children aged 2 years to 12 years admitted with clinical differential diagnosis of tuberculosis. Among them 46 children meeting the case definition were taken as cases and 46 were age, sex and disease presentation matched controls.</p> <p><strong>Results: </strong>Sensitivity of the score was low (50%) but the specificity was high (95%) with 92% positive predictive value and a negative predictive value of 65.67%. Contact with an adult suffering from tuberculosis, positive Mantoux test (&gt;10mm in duration) were found to be the most important indicators of TB in children. Males were found to be affected twice as much as the females.</p> <p><strong>Conclusion: </strong>From the findings of the study, it can be concluded that the Crofton, Horne, Miller score chart is a simple and cost-effective tool, which can be applied to improve the diagnosis of TB in children due to financial constraints faced by patients in resource limited countries like Nepal.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Serum C - Reactive Protein, White Cell Counts and Neutrophil Percentage are Predictors For Distal Ureteric Calculus Expulsion Rate: A Prospective Study 2019-07-03T19:34:33+00:00 Ram Sagar Shah Kaushal Sigdel <p><strong>Background: </strong>To determine the relationship between expulsion rate of distal ureteric calculus less than orequal to 10mm in size and C reactive protein (CRP) level, white cell count and neutrophil percentage.</p> <p><strong>Materials and Methods: </strong>A total of 186 patients with distal ureteric calculus of ≤10mm were evaluated for stone expulsion rate and its correlation with serum CRP, white cell count and neutrophil percentage. All patients received tablet Tamsulosin 0.4mg for 4 weeks or till the expulsion of stone. Patients were called weekly till 4 weeks, or early if there was history of stone expulsion. Patients were divided in two groups according to normal and elevated CRP levels, white cell count and neutrophil percent age at baseline for statistical analysis.</p> <p><strong>Results: </strong>The patients had an average age of 35.6 } 13.9 years. 52.2% were male. Ratio of right to left was1.58:1. Majority of the patients with distal ureteric calculus ≤ 10mm passed their stone (74.7 %) with medical expulsion therapy. Expulsion of stone less than 5mm was statistically significant (p0.017). Patients with normal neutrophil percentage and normal CRP level had higher stone expulsion rate than elevated neutrophil or CRP (85.2% vs. 40.9, 91.8% vs. 30.8% respectively).In patients with normal white cell count, 86.4% passed their stone while in elevated white cellcount group 39.1% passed their stone.</p> <p><strong>Conclusion: </strong>This study showed patients with distal ureteric calculus of ≤10mmwith normal CRP level and normal neutrophil count had higher expulsion rate while WBC count showed no statistically significant association.</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement## Broad Ligament Hematoma Following Vaginal Delivery –A Rare Entity 2019-07-03T19:34:21+00:00 Rakina Bhansakarya Shanti Subedi <p>Pelvic hematomas are common occurring in delivering the baby but spontaneous broad ligament hematoma following vaginal delivery is rarely seen and less than 100 cases are reported in literature. This article reports a rare case of broad ligament hematoma following vacuum delivery in 22 years Para1 lady with history of postpartum collapse 3 hours after delivery.</p> <p>&nbsp;</p> 2019-06-16T00:00:00+00:00 ##submission.copyrightStatement##