Journal of Nobel Medical College 2019-12-30T06:07:10+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> Overweight is a Health Problem to be Tackled with Strict Dietary Restriction and Exercise 2019-12-29T13:52:12+00:00 Arambam Giridhari Singh <p>Not available</p> 2019-12-15T00:00:00+00:00 ##submission.copyrightStatement## Effectiveness of Information Education and Communication on Menstrual Hygiene among Adolescent School Girls of Jumla District 2019-12-29T13:52:14+00:00 Anika Dahal Kamal Prasad Acharya <p><strong>Background:</strong> Menstruation and menstrual practices are darkened by taboos and different societal as well as cultural restrictions, which results in lack of adequate knowledge in adolescents regarding the scientific facts of menstruation as well as healthy menstrual hygiene practices. The objective of the study was to find out the effectiveness of information, education and communication (IEC) on menstrual hygiene among adolescents of Jumla district.</p> <p><strong>Materials and Methods:&nbsp;</strong>Quasi-experimental research design was used for the study. The samples were taken from government school, Shree Janta Secondary Technical school of Chandannath municipality of Jumla District. A total of 112 adolescents girls studying in class 9 and class 10 were selected by using non probability total enumerative sampling technique. Data was collected by using self administered questionnaire. Data analysis was done by descriptive and inferential statistics.</p> <p><strong>Results:&nbsp;</strong>The study revealed that 8.9% of respondents had high knowledge during pre test which was significantly increased to 60.7%&nbsp; during post test and 27.7% of respondents had good practice during pre test which was significantly increased to 51.8%&nbsp; during post test.</p> <p><strong>Conclusion:&nbsp;</strong>The present study concluded that adolescents lacked appropriate knowledge and practices about menstruation in the pre test which significantly increased in post test. Thus, structured health education program can significantly bring positive change in healthy menstrual hygiene practices.</p> 2019-12-15T00:00:00+00:00 ##submission.copyrightStatement## Evaluation of Extracranial Carotid Arteries in Ischemic Stroke Patients Using Color Doppler Sonography and Correlation with Various Risk Factors 2019-12-29T13:52:17+00:00 Manish Raj Pathak Mahesh Gautam Yagya Raj Pathak <p><strong>Background:&nbsp;</strong>Cerebral ischemic stroke is the major cause of death after ischemic heart disease and malignancies, among which major cases of stroke results from atherosclerosis of intra and extra-cranial carotid vessels. The aim of this study is to evaluate the extracranial carotid arteries in patients with ischemic stroke and correlation with various risk factors.</p> <p><strong>Materials and Methods:&nbsp;</strong>A cross sectional study of the patients with ischemic stroke presented in Radiology department of Nobel Medical College were evaluated for a period of one year from February 2017- January 2018 using color Doppler ultrasound and correlated with various risk factors. A total of 50 patients were included in the study. All age groups and sex were included.</p> <p><strong>Results:&nbsp;</strong>Out of 50 patients, 29 patients (58%) were males and 21 patients (42%) were females. Stroke was present in 24 patients on right side and 26 patients on left side. A total of 36 patients had extra-cranial carotid stenosis<strong>. </strong>Among them, 18 patients had &lt;50% stenosis, 17 patients had &gt;50% stenosis and 1 patient had complete occlusion. The most common cause of obstruction was found to be atherosclerotic changes in the form of atheromatous plaque. Out of 50 patients 27 had history of hypertension and 19 had history of smoking. Out of 27 hypertensive patients, 23 had stenosis which is statistically significant (p value 0.024).<strong>&nbsp;</strong></p> <p><strong>&nbsp; Conclusion:&nbsp;</strong>The current study shows the importance of color Doppler ultrasound as an economic, safe and non-invasive method of demonstrating the cause of stroke in extra-cranial carotid artery system</p> 2019-12-15T00:00:00+00:00 ##submission.copyrightStatement## Non-Invasive Predictors of Esophageal Varices in Alcoholic Chronic Liver Disease 2019-12-29T13:52:18+00:00 Rishab Shrestha Alisha Rajbhandari Pradip Chaudhary Kausal Sigdel <p><strong>Background:</strong> Alcohol is widely consumed socially accepted recreational beverage, that is toxic and affects directly or indirectly almost every organ. Spectrum of alcoholic liver disease ranges from fatty liver to cirrhosis. One of the complications of the later spectrum is portal hypertension, around 50% develops varices and bleeding depends on the size of the varices. Predicting varices without endoscopic is difficult but few non-invasive parameters are available.</p> <p><strong>Materials and Methods</strong>: It was a prospective cross-sectional study done in Nobel Medical College Teaching Hospital, Biratnagar, Nepal from September 2018 to August 2019. Approval was acquired from Institutional Review Committee. Patients with chronic ethanol ingestion and features suggestive of chronic liver disease clinically and investigation wise were enrolled in the study. History, physical examinations along with platelet count, prothrombin time was taken and ultrasonography abdomen and upper gastrointestinal endoscopy was done to see the splenic diameter, and varices.</p> <p><strong>Results:</strong> Esophageal varices were present in 53%. Mean platelet count with variceswas 122566 ± 36024.8 /mm<sup>3</sup>, splenic diameter was 133.1 ± 21.3 mm, prothrombintime (PT) time was 19.3 ± 5.0 sec andratio of platelet per spleen diameter was 930.2 ± 259.4 /mm<sup>3</sup>/mm.Platelet count &lt; 163500/mm<sup>3</sup> has sensitivity and specificity 83.0% and 83.0% respectively. Ratio of platelet per splenic diameter ratio cutoff 1293.7 has 88.7% sensitivity and 85.1% specificity for predicting varices.</p> <p><strong>Conclusion:</strong> In chronic alcoholic liver disease patients low platelet count, increased splenicdiameter, low platelet per splenic diameter ratio are useful in predicting presence of esophageal varices.</p> 2019-12-15T00:00:00+00:00 ##submission.copyrightStatement## A Study on Morphological Variations of Fissures and Lobes of Human Lungs with its Clinical Significance 2019-12-29T13:52:20+00:00 Dil Islam Mansur Nabin Bista Pragya Shrestha Sunima Maskey <p><strong>Background: </strong>Fissures of lungs facilitate the movement of lobes which helps in expansion of lungs during breathing.&nbsp; The fissures may be complete, incomplete or absence. Sometime the accessory fissures may also present. Awareness of variations is essential during segmental resections as well as during radiological interpretation of lungs. Hence, the present study was aimed to study the morphological variations in fissures and lobes.</p> <p><strong>Material and Methods: </strong>This study was consisted of sixty nine human lungs with irrespective of sex which were available in the department of anatomy of various medical colleges. All lung specimens were carefully observed and recorded for the presence of any variations in fissures and lobes.</p> <p><strong>Results: </strong>The present study revealed that the absence of horizontal fissure was observed in 7.89%, while no specimen showed absence of oblique fissure on both sides. 35.48% of left lungs had incomplete oblique fissure compared to 28.95% of the right lungs. In addition, 22.58% of right lungs and 23.68% of left lungs showed presence of accessory fissure and lobes. From above, the incomplete and absent horizontal fissure was the most common abnormalities observed in this study. The accessory fissures were more common in lower lobe of right lung whereas in left lungs it was more common in upper lobe.</p> <p><strong>Conclusion: </strong>The present study showed the wide range of variations in fissures and lobes of lungs. The knowledge of variations in morphology of lungs would be helpful for clinical diagnosis and pulmonary surgical procedures.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## A Comparative Study of Dexmedetomidine and Esmolol on Hemodynamic Responses During Laparoscopic Cholecystectomy 2019-12-29T13:52:21+00:00 Sangeeta Subba Richa Mishra Rupak Bhattarai Arjun Chhetri <p><strong>Background: </strong>Laparoscopic surgery has various advantages like minimal invasiveness and quick recovery. However carbon dioxide used for pneumoperitoneum during laparoscopic surgery causes increase in heart rate, blood pressure and systemic vascular resistance. The present study compared the efficacy of Dexmedetomidine and Esmolol on hemodynamic responses during laparoscopic cholecystectomy.</p> <p><strong>Material and Methods: </strong>A total of 100 patients scheduled for laparoscopic cholecystectomy were randomly allocated in two groups, 50 in each group. Esmolol group received bolus dose of 1 mg/kg intravenous Esmolol just before pneumoperitoneum followed by an infusion of 200 mcg/kg/minand Dexmeditomidine group &nbsp;received bolus dose of 1 mcg/kg iv Dexmedetomidine over 10 minutes before pneumoperitoneum&nbsp; followed by 0.6 mcg/kg/hr in infusion. Hemodynamic parameters like Heart rate, Mean arterial pressure, Systolic blood pressure, Diastolic blood pressure were recorded at different time intervals.</p> <p><strong>Results: </strong>It was found that in Dexmeditomidine group&nbsp; there was a statistically significant decrease in heart rate before pneumoperitoneum (84.24±9.17) and 10 minutes after pneumoperitoneum (79.40±7.41)compared to Esmolol Group&nbsp; before pneumoperitoneum (91.40±5.98) and10 minutes after pneumoperitoneum (95.18±14.17).There was statistically significant decrease in Mean arterial pressure in Dexmeditomidine group&nbsp; at&nbsp; 30 minutes (86.53±6.13), 50 minutes (77.95±4.85) , after release of pneumoperitoneum (92.42±3.91) and after extubation (99.50±11.81) compared&nbsp; to Esmolol group&nbsp; at 30 minutes (91.23±8.97), 50 minutes (94.34±12.64) after release of pneumoperitoneum (102.5±10.44) and after extubation (112.39±11.15).</p> <p><strong>Conclusion: </strong>Dexmedetomidine was found to be more effective than Esmolol in attenuating the hemodynamic responses following pneumoperitoneum during laparoscopic cholecystectomy.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Study of Extended Spectrum Beta-Lactamases Producing Escherichia Coli and Klebsiella Species in a Tertiary Care Hospital, Biratnagar, Nepal 2019-12-29T13:52:22+00:00 Kumari Ragani Yadav Ganesh kumar Singh Sujit Bhattacharjee Kewal Shrestha <p><strong>Background: </strong><em>Escherichia coli </em>and <em>Klebsiella</em> species are most common ESBL producers and associated with UTI in both community and hospital setting, often limiting the treatment therapy of UTI. Aim of present study was Isolation and Identification of ESBL producing <em>E. coli</em> and<em> Klebsiella</em> Species in urine sample from cases of UTI and their antibiotic susceptibility pattern at Nobel Medical College Teaching Hospital, Biratnagar, Nepal.</p> <p><strong>Materials and Methods: </strong>This descriptive cross-sectional study was conducted at Nobel Medical College with effect from October 2018 to June 2019 after approval from the Institutional Review Committee (IRC) of the college as per clinical laboratory standards institute of (CLSI) guidelines.</p> <p><strong>Results: </strong>Out of total 2567 urine samples, 631(24.5%) samples showed microbial growth. Among which <em>E. coli</em> was 288(45.6%), <em>Klebsiella</em> species were 20(31.5%), other gram-negative bacteria were 158(25%), gram positive bacteria were 114(18%) and fungus 51(8%) were recovered. Out of 631 culture positive urine samples, 308 urine samples were positive for <em>E. coli</em>/<em>K</em>. species 288(93.5%)/20(42.5%) respectively. Among which ESBL isolates were 213(69%) and non ESBL isolates were 95(31%). All ESBL producing <em>E. coli</em> and <em>K.</em> species were found (100%) sensitive to meropenem. Similarly, among other antibiotics also showed increased susceptibility towards the piperacillin/tazobactum (97.2%),cefoperazone/sulbactum (94.4%) and amikacin (93.0%).</p> <p><strong>Conclusion: </strong>The highest numbers of ESBL producers <em>E. coli</em> and <em>K</em>. species from urine sample are increasing day by day and creating serious problem in treating patients in Nepal. So it should be mandatory and very essential to have routine monitoring system to detect the ESBL producing isolates in clinical laboratories.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Clinical Features, Treatment Choices and in-Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction in Eastern Region of Nepal: A Hospital-Based Study 2019-12-30T06:07:10+00:00 Rajesh Nepal Sahadeb Prasad Dhungana <p><strong>Background: </strong>Patients with Acute ST-elevation myocardial infarction (STEMI) have different modes of presentation, treatment options and outcomes which vary across the different population. There is a paucity of data about the clinical characteristics of acute STEMI from the eastern part of Nepal. Our study aimed to assess the clinical characteristics and in-hospital outcome of patients with acute STEMI at a tertiary care center of the eastern part of Nepal.</p> <p><strong>Materials and Methods: </strong>This is a descriptive cross-sectional study on 214 patients who presented in the emergency room or coronary care unit of Nobel Medical College Teaching Hospital from August 2018 to July 2019. Demographic features, risk factors, duration of symptoms before presentation, different treatment options offered and the in-hospital outcome were noted.</p> <p><strong>Results: </strong>The male to female ratio was 2.14. The most common symptom was chest pain (97.0%) followed by sweating 78.0%, breathlessness 29.0%, nausea or vomiting 24.8 %, etc. The most common regional territory involved was the anterior wall (48.1%) followed by the Inferior wall (42.5 %), posterior wall (5.1 %). The majority (71.3%) presented within 12 hours after symptom onset.&nbsp; Hypertension was the most frequent (40.2%) risk factor followed by Smoking (39.7%), diabetes mellitus (35.0%) and dyslipidemia (34.6%). Among patients eligible for primary PCI - 76.6% underwent PCI, 22.0% were managed conservatively. Total mortality among patients managed with primary PCI was 3% as compared to medical therapy (14.8%). Heart failure prevalence was less with primary PCI (12.1%) compared to medical therapy (29.6%).</p> <p><strong>Conclusion: </strong>The majority of patients presented with typical symptoms in a reasonably early period (12 hrs) and the in-hospital outcome was better with primary PCI.&nbsp; Hence, efforts should be made to offer primary PCI to the majority of patients in the peripheral part of our country.</p> 2019-12-17T00:00:00+00:00 ##submission.copyrightStatement## Outcome of Corrective Dome Osteotomy for Cubitus Varus Deformity 2019-12-29T13:52:25+00:00 Ranjib Kumar Jha Santosh Thapa Dhiraj Singh <p><strong>Background: </strong>The cubitus varus deformity is one of the most common late complications of fracture supracondylar area of humerus in children. Various corrective osteotomies are used of which lateral closed wedge osteotomy is commonly done which has its own disadvantages like lateral condylar prominence, difficulty in achieving correction and limitation of movement. Dome osteotomy is a versatile technique to achieve correction of deformity in all planes and to overcome these above complications. The aim of this study was to evaluate the results of dome osteotomy for correction of post-traumatic cubitus varus deformity of elbow in children.</p> <p><strong>Materials and Methods: </strong>The study included 18 children between 6-13 years of age of both sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity. After appropriate pre- operative assessment, dome osteotomy was done by posterior approach. In pre and post operative x-ray carrying angle and lateral condylar prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated.</p> <p><strong>Results: </strong>In this study of 18 patients, 12 were males and 6 were females. The age ranged from 6-13 yrs with average of 8.4yrs. The average correction of carrying angle was from -22.4 degree to +10 degree. LCPI changed post operatively ranging from -8.6% to +3.25%, average -2.9%. There were no significant complications. Fifteen patients had excellent outcome and 3 had good outcome.</p> <p><strong>Conclusion: </strong>The results in our study concluded that dome osteotomy for cubitus varus is safe and effective method and give cosmetically more acceptable elbow.</p> 2019-12-18T00:00:00+00:00 ##submission.copyrightStatement## Determination of Relationship of Maxillary Occlusal Plane with Ala-Tragus Line: A Customised Approach in Aryan and Mongolian Ethnicity. 2019-12-29T13:52:26+00:00 Pawan Mehta Shanti Chhetri <p><strong>Background: </strong>Determining occlusal plane is challenging and difficult aspect during complete removable partial denture prosthesis rehabilitation. Numerous soft tissue landmarks like commissures of the mouth by Gillis in 1933, parotid papilla by P. F. Foley and G. H. Latta in 1985, height of the retromolar pad, the lateral borders of the tongue etc. had been proposed to assist clinician for determining the occlusal plane. No universally accepted reliable anatomical measurement has been proposed to assist in determining of occlusion plane for different ethnic groups in context to Nepal.</p> <p><strong>Material &amp; Methods: </strong>This cross-sectional study was conducted in the 60 dentate subjects visiting Nobel Medical College, Nepal, from February 2019 to July 2019. A customized occlusal plane relator was used to evaluate relative parallelism between occlusal plane and alatragal line with respect to different borders of tragus. All the data were collected and statistically analyzed.</p> <p><strong>Results: </strong>Maxillary occlusal plane was found to be parallel with the line drawn from ala of the nose to the middle of tragus in 66.66%, followed by inferior border of tragus in 18.33% with the least parallelism in superior border of tragus 15%. Relationship of maxillary occlusal plane with alatragal line was not statistically significant among Aryans and Mongolian ethnicity</p> <p><strong>Conclusion: </strong>This study showed line joining ala of the nose and middle border of tragus is parallel to maxillary occlusal plane. And no difference was found for Aryan &amp; Mongolian ethnicity in relation to alatragal line and maxillary occlusal plane.</p> 2019-12-19T00:00:00+00:00 ##submission.copyrightStatement## Clinical Profile of Patients with Seizure in Kathmandu Medical College Teaching Hospital. 2019-12-29T13:52:27+00:00 Krishna Dhungana Dipesh Shakya Rabindra Shrestha Sabnam Bhatta Sabbu Maharjan <p><strong>Background: </strong>Seizure is a common clinical condition. It represents a majority of patients visiting neurology OPD as well as inpatient department in Kathmandu Medical College Teaching Hospital. While the number of patients with seizure is increasing in Nepal, data on the clinical profile of patients with seizure is scarce. Thus, this study aims to find out the relative frequency of seizure in different age and sex groups. It also aims to find out the common causes of seizure in our Nepalese population.</p> <p><strong>Materials and Methods: </strong>A descriptive cross sectional study was carried out in patients attending outpatient and inpatient of Neurology department of Kathmandu Medical College Teaching Hospital between periods of July 2018 to December 2018. Demographic characteristics, radiographic findings, EEG findings and drugs taken by patients were recorded according to the proforma.</p> <p><strong>Results: </strong>Data from one hundred patients were collected and analyzed. Most of the patients were less than 41 years of age. Most of the patients were male. The prime cause of seizure was found to be neurocysticercosis (25%). Majority of the patients were on monotherapy.</p> <p><strong>Conclusion: </strong>Our data regarding the frequency of seizure in different age and sex groups is comparable to data in South East Asia region whilst, different from the western data. In our population, neurocysticercosiswas the most common cause of seizures. Also, most seizures were controlled with monotherapy.</p> 2019-12-22T00:00:00+00:00 ##submission.copyrightStatement## Cytological Evaluation of Thyroid and its Correlation with Thyroid Function Test and Anti-Thyroid Peroxidase in a Patient of Hashimoto’s Thyroiditis 2019-12-29T13:52:28+00:00 Manish Kumar Das Meenakshi Basnet <p><strong>Background</strong>: A thyroid swelling is an enlargement of thyroid glands causes by iodine deficiency, ageing, autoimmune disease and benign or malignant tumors. Autoimmune thyroiditis is the second most common thyroid lesion diagnosed after goiter.</p> <p><strong>Materials and Methods</strong>: To find out the distribution of thyroid gland swelling in patients visiting otorhinolaryngology department of Nobel medical college and correlate serum thyroid function test and anti-thyroid peroxidase level with fine needle aspiration cytology reports.</p> <p><strong>Results</strong>: The mean age of patient with thyroid gland lesions was 40.47 ± 13.05 years. Out of 87 patients studied, the highest number of patients (37, 42.5%) was diagnosed with colloid goiter followed by autoimmune thyroiditis (29, 33.3%). The mean age of patients with autoimmune thyroiditis was found to be 38.66 ± 12.31 years. The sensitivity and specificity of anti-thyroid peroxidase antibodies for diagnosing autoimmune thyroiditis was 89.7% and 94.8% respectively.</p> <p><strong>Conclusion</strong>: Autoimmune thyroiditis has statistical correlation with serum anti-thyroid peroxidase antibodies and it can be effectively used as an alternative tool in diagnosing autoimmune thyroiditis with acceptable diagnostic accuracy.</p> 2019-12-22T00:00:00+00:00 ##submission.copyrightStatement## Factors Affecting Satisfaction Regarding Maternity Services Among Postnatal Mothers in a Tertiary Hospital of Kathmandu 2019-12-29T13:52:29+00:00 Puspa Parajuli Narayani Paudel <p><strong>Background: </strong>Maternal satisfaction towards care provided during pregnancy, childbirth and puerperium is one of the key outcome measures for quality of care. In order to provide satisfactory maternity services health workers should focus on mother-friendly care. Various factors may affect on mothers' satisfaction regarding maternity services.The objective of this study was to assess the factors affecting satisfaction regarding maternity services among postnatal mothers.</p> <p><strong>Materials and Methods: </strong>A descriptive, cross-sectional study was conducted in postnatal ward of Kathmandu Medical College Teaching Hospital. A total of 180 postnatal mothers were purposively selected for the study. Ethical clearance was obtained from the institutional review committee of Kathmandu Medical College. Face to face interview technique was used to collect the data using pre – designed structured questionnaire. Data collection was done from June to July 2019. Data were analysed using Statistical Package for Social Science 20.0 version. Both descriptive and inferential statistics were used for data analysis.</p> <p><strong>Results: </strong>Majority (83.9%) of the mothers were satisfied with overall maternity services. The level of satisfaction was higher in (82.8%) environmental factor, (80%) health care delivery system of hospital and (73.3%) communication. There was significant association between sexes of current child with maternal satisfaction.&nbsp; Mothers having current child male were more satisfied with maternity services provided by the hospital (COR: 4.90 with 95% CI: 1.97, 12.18).</p> <p><strong>Conclusion: </strong>The study concluded that majority of postnatal mothers were satisfied with maternity services provided at hospital. Current child male was significantly associated with satisfaction level of mothers on maternity services.</p> 2019-12-22T00:00:00+00:00 ##submission.copyrightStatement## Metastatic Cutaneous Melanoma: A Rare Entity with a Unique Presentation 2019-12-29T13:52:16+00:00 Manish Pradhan Deepa Rai Rashmi Bhandari <p>The occurrence of cutaneous infiltration by malignancies has been accounted to 0.7 %- 9 % of patients suffering with malignant neoplasm and are generally thought to be a late consequence of most neoplasms.And, the prevalence of malignant melanoma as a primary tumor in one published study was 59 out of 381 patients. We herein report an unusual case of a patient who presented with multiple nodules of varying sizes over the body, which later revealed to be malignant melanoma; both on cytopathology and histopathology examination. As this is a rare, unusual condition in our setting, frequent and timely case reporting is to be done that will ensure the better management and outcome of the disease</p> 2019-12-17T00:00:00+00:00 ##submission.copyrightStatement##